<?php
// ~ print_r($_SESSION);
// ~ print_r($_FILES);
// ~ print_r($_POST);
$_SESSION ['pathway'] = '..';

if (isset ( $_GET ['form'] ) and $_GET ['form'] == 'new') {
	$table = 'diagnostic';
	require_once ("./requetes/recupere_max.php");
	require_once ("./requetes/insere_form_base.php");
	require_once ("./requetes/insere_sara.php");
	require_once ("./requetes/insere_sprs.php");
	$form = $_SESSION ['form'];
} else {
	$form = $_GET ['form'];
}

?>Form <?php

echo $form;
?><?php

if (! isset ( $_SESSION ['id'] )) {
	echo "<table class='principale'><tr><td>Session expired</td></tr>";
	echo "<a href='" . $_SESSION ['pathway'] . "/index.php'>Start</a></table>";
} elseif ($_SESSION ['acces_clinique'] == 0) {
	echo "<table class='principale'><tr><td>Restricted area</td></tr>";
	echo "<a href='" . $_SESSION ['pathway'] . "/start.php'>Home</a></table>";
} else {
	
	// ~ $link = mysqli_connect($host, $userbase, $passwd) or die('Impossible de se connecter pour récupérer niveau : ' . mysql_error());
	mysql_select_db ( $db ) or die ( 'Impossible de s&#233;lectionner la base de donn&#233;es' );
	if ($form != '') {
		// ~ mysqli_select_db($link,$db) or die('Impossible de s&#233;lectionner la base de donn&#233;es'); if($form != ''){
		
		$_SESSION ['form'] = $form;
		
		$query_fichiersattaches = "SELECT `fichiersattaches`
		FROM `diagnostic`
		WHERE `form` LIKE " . $form;
		$resultat_fichiersattaches = mysql_query ( $query_fichiersattaches ) or die ( "impossible de remplir le questionnaire : " . mysql_error () );
		// ~ $resultat_fichiersattaches = mysqli_query($link,$query_fichiersattaches) or die("impossible de remplir le questionnaire : " . mysql_error());
		$fichiers_attaches_base = mysql_fetch_array ( $resultat_fichiersattaches );
		// ~ $fichiers_attaches_base = mysqli_fetch_array($resultat_fichiersattaches);
		
		$fichiersattaches = $fichiers_attaches_base ['fichiersattaches'];
		if (isset ( $_GET ['delete'] )) {
			$fichiersattaches = str_replace ( $_GET ['delete'] . ';', '', $fichiersattaches );
			unlink ( "../uploads/" . $_GET ['delete'] );
			$query_update_fichiers = "UPDATE `spatax`.`diagnostic` SET `fichiersattaches` = '$fichiersattaches' WHERE `diagnostic`.`form` = " . $form;
			mysql_query ( $query_update_fichiers ) or die ( "impossible d'updater fichiers : " . mysql_error () );
			// ~ mysqli_query($link,$query_update_fichiers) or die("impossible d'updater fichiers : " . mysql_error());
		}
		
		if (isset ( $_GET ['submit'] ) and $_GET ['submit'] == 'yes') {
			
			if (isset ( $_POST ['user'] )) {
				$user = $_POST ['user'];
			} else {
				$user = '';
			}
			$last_modifier = $_SESSION ['id']; // dès qu'on soumet le formulaire, le last_modifier est actualisé
			
			if (isset ( $_POST ['date'] )) {
				$date = $_POST ['date'];
			} else {
				$date = '';
			}
			if (isset ( $_POST ['center'] )) {
				$center = $_POST ['center'];
			} else {
				$center = '';
			}
			if (isset ( $_POST ['neurologist'] )) {
				$neurologist = $_POST ['neurologist'];
			} else {
				$neurologist = '';
			}
			if (isset ( $_POST ['code1'] )) {
				$code1 = $_POST ['code1'];
			} else {
				$code1 = '';
			}
			if (isset ( $_POST ['code2'] )) {
				$code2 = $_POST ['code2'];
			} else {
				$code2 = '';
			}
			if (isset ( $_POST ['code3'] )) {
				$code3 = $_POST ['code3'];
			} else {
				$code3 = '';
			}
			if (isset ( $_POST ['code4'] )) {
				$code4 = $_POST ['code4'];
			} else {
				$code4 = '';
			}
			if (isset ( $_POST ['code5'] )) {
				$code5 = $_POST ['code5'];
			} else {
				$code5 = '';
			}
			if (isset ( $_POST ['nip'] )) {
				$nip = $_POST ['nip'];
			} else {
				$nip = '';
			}
			if (isset ( $_POST ['birthdate'] )) {
				$birthdate = $_POST ['birthdate'];
			} else {
				$birthdate = '';
			}
			if (isset ( $_POST ['proband'] )) {
				$proband = $_POST ['proband'];
			} else {
				$proband = '';
			}
			if (isset ( $_POST ['sex'] )) {
				$sex = $_POST ['sex'];
			} else {
				$sex = '';
			}
			if (isset ( $_POST ['initialexam'] )) {
				$initialexam = $_POST ['initialexam'];
			} else {
				$initialexam = '';
			}
			if (isset ( $_POST ['followup'] )) {
				$followup = $_POST ['followup'];
			} else {
				$followup = '';
			}
			
			if (isset ( $_POST ['ps_or_ataxia_in_family'] )) {
				$ps_or_ataxia_in_family = $_POST ['ps_or_ataxia_in_family'];
			} else {
				$ps_or_ataxia_in_family = '';
			}
			if (isset ( $_POST ['other_familial_disease'] )) {
				$other_familial_disease = $_POST ['other_familial_disease'];
			} else {
				$other_familial_disease = '';
			}
			if (empty ( $_POST ['other_familial_disease'] )) {
				$other_familial_disease = '';
			}
			if (isset ( $_POST ['specify_other_familial_disease'] )) {
				$specify_other_familial_disease = $_POST ['specify_other_familial_disease'];
			} else {
				$specify_other_familial_disease = '';
			}
			if (isset ( $_POST ['consanguinity'] )) {
				$consanguinity = $_POST ['consanguinity'];
			} else {
				$consanguinity = '';
			}
			if (isset ( $_POST ['specify_consanguinity'] )) {
				$specify_consanguinity = $_POST ['specify_consanguinity'];
			} else {
				$specify_consanguinity = '';
			}
			if (isset ( $_POST ['parental_inheritance'] )) {
				$parental_inheritance = $_POST ['parental_inheritance'];
			} else {
				$parental_inheritance = '';
			}
			if (isset ( $_POST ['parental_inheritance_comments'] )) {
				$parental_inheritance_comments = $_POST ['parental_inheritance_comments'];
			} else {
				$parental_inheritance_comments = '';
			}
			if (isset ( $_POST ['geographical_origin'] )) {
				$geographical_origin = $_POST ['geographical_origin'];
			} else {
				$geographical_origin = '';
			}
			if (isset ( $_POST ['age_of_death'] )) {
				$age_of_death = $_POST ['age_of_death'];
			} else {
				$age_of_death = '';
			}
			
			if (isset ( $_POST ['onset_age'] )) {
				$onset_age = $_POST ['onset_age'];
			} else {
				$onset_age = '';
			}
			if (isset ( $_POST ['examination_age'] )) {
				$examination_age = $_POST ['examination_age'];
			} else {
				$examination_age = '';
			}
			
			if (isset ( $_POST ['motor_development'] )) {
				$motor_development = $_POST ['motor_development'];
			} else {
				$motor_development = '';
			}
			if (isset ( $_POST ['specify_motor_development'] )) {
				$specify_motor_development = $_POST ['specify_motor_development'];
			} else {
				$specify_motor_development = '';
			}
			if (isset ( $_POST ['intellect_development'] )) {
				$intellect_development = $_POST ['intellect_development'];
			} else {
				$intellect_development = '';
			}
			if (isset ( $_POST ['specify_intellect_development'] )) {
				$specify_intellect_development = $_POST ['specify_intellect_development'];
			} else {
				$specify_intellect_development = '';
			}
			if (isset ( $_POST ['dysarthria'] )) {
				$dysarthria = $_POST ['dysarthria'];
			} else {
				$dysarthria = '';
			}
			if (isset ( $_POST ['stiff_legs'] )) {
				$stiff_legs = $_POST ['stiff_legs'];
			} else {
				$stiff_legs = '';
			}
			if (isset ( $_POST ['cramps'] )) {
				$cramps = $_POST ['cramps'];
			} else {
				$cramps = '';
			}
			if (isset ( $_POST ['pain'] )) {
				$pain = $_POST ['pain'];
			} else {
				$pain = '';
			}
			if (isset ( $_POST ['diplopia_at_onset'] )) {
				$diplopia_at_onset = $_POST ['diplopia_at_onset'];
			} else {
				$diplopia_at_onset = '';
			}
			if (isset ( $_POST ['other_signs_onset'] )) {
				$other_signs_onset = $_POST ['other_signs_onset'];
			} else {
				$other_signs_onset = '';
			}
			if (isset ( $_POST ['specify_other_signs_onset'] )) {
				$specify_other_signs_onset = $_POST ['specify_other_signs_onset'];
			} else {
				$specify_other_signs_onset = '';
			}
			
			if (isset ( $_POST ['spasticity_upper_limbs'] )) {
				$spasticity_upper_limbs = $_POST ['spasticity_upper_limbs'];
			} else {
				$spasticity_upper_limbs = '';
			}
			if (isset ( $_POST ['spasticity_lower_limbs'] )) {
				$spasticity_lower_limbs = $_POST ['spasticity_lower_limbs'];
			} else {
				$spasticity_lower_limbs = '';
			}
			if (isset ( $_POST ['spasticity_gait'] )) {
				$spasticity_gait = $_POST ['spasticity_gait'];
			} else {
				$spasticity_gait = '';
			}
			if (isset ( $_POST ['spasticity_dysarthria'] )) {
				$spasticity_dysarthria = $_POST ['spasticity_dysarthria'];
			} else {
				$spasticity_dysarthria = '';
			}
			if (isset ( $_POST ['ataxia_upper_limbs'] )) {
				$ataxia_upper_limbs = $_POST ['ataxia_upper_limbs'];
			} else {
				$ataxia_upper_limbs = '';
			}
			if (isset ( $_POST ['ataxia_lower_limbs'] )) {
				$ataxia_lower_limbs = $_POST ['ataxia_lower_limbs'];
			} else {
				$ataxia_lower_limbs = '';
			}
			if (isset ( $_POST ['ataxia_gait'] )) {
				$ataxia_gait = $_POST ['ataxia_gait'];
			} else {
				$ataxia_gait = '';
			}
			if (isset ( $_POST ['ataxia_dysarthria'] )) {
				$ataxia_dysarthria = $_POST ['ataxia_dysarthria'];
			} else {
				$ataxia_dysarthria = '';
			}
			
			if (isset ( $_POST ['disability_stage'] )) {
				$disability_stage = $_POST ['disability_stage'];
			} else {
				$disability_stage = '';
			}
			if (isset ( $_POST ['age_disability_stage3'] )) {
				$age_disability_stage3 = $_POST ['age_disability_stage3'];
			} else {
				$age_disability_stage3 = '';
			}
			if (isset ( $_POST ['age_disability_stage4'] )) {
				$age_disability_stage4 = $_POST ['age_disability_stage4'];
			} else {
				$age_disability_stage4 = '';
			}
			if (isset ( $_POST ['age_disability_stage5'] )) {
				$age_disability_stage5 = $_POST ['age_disability_stage5'];
			} else {
				$age_disability_stage5 = '';
			}
			if (isset ( $_POST ['age_disability_stage6'] )) {
				$age_disability_stage6 = $_POST ['age_disability_stage6'];
			} else {
				$age_disability_stage6 = '';
			}
			if (isset ( $_POST ['age_disability_stage7'] )) {
				$age_disability_stage7 = $_POST ['age_disability_stage7'];
			} else {
				$age_disability_stage7 = '';
			}
			
			if (isset ( $_POST ['jaw_jerk'] )) {
				$jaw_jerk = $_POST ['jaw_jerk'];
			} else {
				$jaw_jerk = '';
			}
			if (isset ( $_POST ['biceps'] )) {
				$biceps = $_POST ['biceps'];
			} else {
				$biceps = '';
			}
			if (isset ( $_POST ['finger_flexor'] )) {
				$finger_flexor = $_POST ['finger_flexor'];
			} else {
				$finger_flexor = '';
			}
			if (isset ( $_POST ['patellar'] )) {
				$patellar = $_POST ['patellar'];
			} else {
				$patellar = '';
			}
			if (isset ( $_POST ['adductor'] )) {
				$adductor = $_POST ['adductor'];
			} else {
				$adductor = '';
			}
			if (isset ( $_POST ['ankle'] )) {
				$ankle = $_POST ['ankle'];
			} else {
				$ankle = '';
			}
			
			if (isset ( $_POST ['hoffmans_sign'] )) {
				$hoffmans_sign = $_POST ['hoffmans_sign'];
			} else {
				$hoffmans_sign = '';
			}
			if (isset ( $_POST ['plantar_reflex'] )) {
				$plantar_reflex = $_POST ['plantar_reflex'];
			} else {
				$plantar_reflex = '';
			}
			if (isset ( $_POST ['plantar_reflex_right_left'] )) {
				$plantar_reflex_right_left = $_POST ['plantar_reflex_right_left'];
			} else {
				$plantar_reflex_right_left = '';
			}
			
			if (isset ( $_POST ['motor_facial_palsy_atrophy'] )) {
				$motor_facial_palsy_atrophy = $_POST ['motor_facial_palsy_atrophy'];
			} else {
				$motor_facial_palsy_atrophy = '';
			}
			if (isset ( $_POST ['motor_proximal_UL'] )) {
				$motor_proximal_UL = $_POST ['motor_proximal_UL'];
			} else {
				$motor_proximal_UL = '';
			}
			if (isset ( $_POST ['motor_distal_UL'] )) {
				$motor_distal_UL = $_POST ['motor_distal_UL'];
			} else {
				$motor_distal_UL = '';
			}
			if (isset ( $_POST ['motor_proximal_LL'] )) {
				$motor_proximal_LL = $_POST ['motor_proximal_LL'];
			} else {
				$motor_proximal_LL = '';
			}
			if (isset ( $_POST ['motor_distal_LL'] )) {
				$motor_distal_LL = $_POST ['motor_distal_LL'];
			} else {
				$motor_distal_LL = '';
			}
			
			if (isset ( $_POST ['muscle_proximal_UL'] )) {
				$muscle_proximal_UL = $_POST ['muscle_proximal_UL'];
			} else {
				$muscle_proximal_UL = '';
			}
			if (isset ( $_POST ['muscle_distal_UL'] )) {
				$muscle_distal_UL = $_POST ['muscle_distal_UL'];
			} else {
				$muscle_distal_UL = '';
			}
			if (isset ( $_POST ['muscle_proximal_LL'] )) {
				$muscle_proximal_LL = $_POST ['muscle_proximal_LL'];
			} else {
				$muscle_proximal_LL = '';
			}
			if (isset ( $_POST ['muscle_distal_LL'] )) {
				$muscle_distal_LL = $_POST ['muscle_distal_LL'];
			} else {
				$muscle_distal_LL = '';
			}
			
			if (isset ( $_POST ['fasciculations'] )) {
				$fasciculations = $_POST ['fasciculations'];
			} else {
				$fasciculations = '';
			}
			if (isset ( $_POST ['fasciculations_localisation'] )) {
				$fasciculations_localisation = $_POST ['fasciculations_localisation'];
			} else {
				$fasciculations_localisation = '';
			}
			if (isset ( $_POST ['myokymias'] )) {
				$myokymias = $_POST ['myokymias'];
			} else {
				$myokymias = '';
			}
			if (isset ( $_POST ['myokymias_localisation'] )) {
				$myokymias_localisation = $_POST ['myokymias_localisation'];
			} else {
				$myokymias_localisation = '';
			}
			
			if (isset ( $_POST ['vibration_sense'] )) {
				$vibration_sense = $_POST ['vibration_sense'];
			} else {
				$vibration_sense = '';
			}
			if (isset ( $_POST ['superficial_sensory_loss'] ) and $_POST ['superficial_sensory_loss'] != '') {
				$superficial_sensory_loss = $_POST ['superficial_sensory_loss'];
				if (is_array ( $_POST ['superficial_sensory_loss'] )) {
					$superficial_sensory_loss = implode ( ', ', $_POST ['superficial_sensory_loss'] );
				}
			} else {
				$superficial_sensory_loss = '';
			}
			// ~ if(isset($_POST['superficial_sensory_loss'])){ $superficial_sensory_loss = $_POST['superficial_sensory_loss']; }else{ $superficial_sensory_loss = '';}
			
			if (isset ( $_POST ['scoliosis'] )) {
				$scoliosis = $_POST ['scoliosis'];
			} else {
				$scoliosis = '';
			}
			if (isset ( $_POST ['pes_cavus'] )) {
				$pes_cavus = $_POST ['pes_cavus'];
			} else {
				$pes_cavus = '';
			}
			if (isset ( $_POST ['other_skeletal_abnormality'] )) {
				$other_skeletal_abnormality = $_POST ['other_skeletal_abnormality'];
			} else {
				$other_skeletal_abnormality = '';
			}
			if (isset ( $_POST ['other_other_skeletal_abnormality'] )) {
				$other_other_skeletal_abnormality = $_POST ['other_other_skeletal_abnormality'];
			} else {
				$other_other_skeletal_abnormality = '';
			}
			
			if (isset ( $_POST ['facial_dysmorphia'] )) {
				$facial_dysmorphia = $_POST ['facial_dysmorphia'];
			} else {
				$facial_dysmorphia = '';
			}
			if (isset ( $_POST ['describe_facial_dysmorphia'] )) {
				$describe_facial_dysmorphia = $_POST ['describe_facial_dysmorphia'];
			} else {
				$describe_facial_dysmorphia = '';
			}
			
			if (isset ( $_POST ['urinary_urgency'] )) {
				$urinary_urgency = $_POST ['urinary_urgency'];
			} else {
				$urinary_urgency = '';
			}
			if (isset ( $_POST ['urinary_incontinence'] )) {
				$urinary_incontinence = $_POST ['urinary_incontinence'];
			} else {
				$urinary_incontinence = '';
			}
			if (isset ( $_POST ['urinary_retention'] )) {
				$urinary_retention = $_POST ['urinary_retention'];
			} else {
				$urinary_retention = '';
			}
			if (isset ( $_POST ['anal_incontinence'] )) {
				$anal_incontinence = $_POST ['anal_incontinence'];
			} else {
				$anal_incontinence = '';
			}
			if (isset ( $_POST ['impaired_sexual_function'] )) {
				$impaired_sexual_function = $_POST ['impaired_sexual_function'];
			} else {
				$impaired_sexual_function = '';
			}
			if (isset ( $_POST ['early_menopause'] )) {
				$early_menopause = $_POST ['early_menopause'];
			} else {
				$early_menopause = '';
			}
			if (isset ( $_POST ['early_menopause_age'] )) {
				$early_menopause_age = $_POST ['early_menopause_age'];
			} else {
				$early_menopause_age = '';
			}
			
			if (isset ( $_POST ['resting_tremor'] )) {
				$resting_tremor = $_POST ['resting_tremor'];
			} else {
				$resting_tremor = '';
			}
			if (isset ( $_POST ['specify_resting_tremor'] )) {
				$specify_resting_tremor = $_POST ['specify_resting_tremor'];
			} else {
				$specify_resting_tremor = '';
			}
			if (isset ( $_POST ['postural_tremor'] )) {
				$postural_tremor = $_POST ['postural_tremor'];
			} else {
				$postural_tremor = '';
			}
			if (isset ( $_POST ['specify_postural_tremor'] )) {
				$specify_postural_tremor = $_POST ['specify_postural_tremor'];
			} else {
				$specify_postural_tremor = '';
			}
			if (isset ( $_POST ['chorea'] )) {
				$chorea = $_POST ['chorea'];
			} else {
				$chorea = '';
			}
			if (isset ( $_POST ['specify_chorea'] )) {
				$specify_chorea = $_POST ['specify_chorea'];
			} else {
				$specify_chorea = '';
			}
			if (isset ( $_POST ['dystonia'] )) {
				$dystonia = $_POST ['dystonia'];
			} else {
				$dystonia = '';
			}
			if (isset ( $_POST ['specify_dystonia'] )) {
				$specify_dystonia = $_POST ['specify_dystonia'];
			} else {
				$specify_dystonia = '';
			}
			if (isset ( $_POST ['myoclonus'] )) {
				$myoclonus = $_POST ['myoclonus'];
			} else {
				$myoclonus = '';
			}
			if (isset ( $_POST ['specify_myoclonus'] )) {
				$specify_myoclonus = $_POST ['specify_myoclonus'];
			} else {
				$specify_myoclonus = '';
			}
			if (isset ( $_POST ['hypokinesia'] )) {
				$hypokinesia = $_POST ['hypokinesia'];
			} else {
				$hypokinesia = '';
			}
			if (isset ( $_POST ['specify_hypokinesia'] )) {
				$specify_hypokinesia = $_POST ['specify_hypokinesia'];
			} else {
				$specify_hypokinesia = '';
			}
			if (isset ( $_POST ['rigidity'] )) {
				$rigidity = $_POST ['rigidity'];
			} else {
				$rigidity = '';
			}
			if (isset ( $_POST ['specify_rigidity'] )) {
				$specify_rigidity = $_POST ['specify_rigidity'];
			} else {
				$specify_rigidity = '';
			}
			
			if (isset ( $_POST ['diplopia'] )) {
				$diplopia = $_POST ['diplopia'];
			} else {
				$diplopia = '';
			}
			if (isset ( $_POST ['ptosis'] )) {
				$ptosis = $_POST ['ptosis'];
			} else {
				$ptosis = '';
			}
			if (isset ( $_POST ['bulging_eyes'] )) {
				$bulging_eyes = $_POST ['bulging_eyes'];
			} else {
				$bulging_eyes = '';
			}
			if (isset ( $_POST ['diminished_visual_acuity'] )) {
				$diminished_visual_acuity = $_POST ['diminished_visual_acuity'];
			} else {
				$diminished_visual_acuity = '';
			}
			if (isset ( $_POST ['diminished_visual_acuity_age'] )) {
				$diminished_visual_acuity_age = $_POST ['diminished_visual_acuity_age'];
			} else {
				$diminished_visual_acuity_age = '';
			}
			if (isset ( $_POST ['abnormal_fundus'] )) {
				$abnormal_fundus = $_POST ['abnormal_fundus'];
			} else {
				$abnormal_fundus = '';
			}
			if (isset ( $_POST ['other_abnormal_fundus'] )) {
				$other_abnormal_fundus = $_POST ['other_abnormal_fundus'];
			} else {
				$other_abnormal_fundus = '';
			}
			if (isset ( $_POST ['other_other_abnormal_fundus'] )) {
				$other_other_abnormal_fundus = $_POST ['other_other_abnormal_fundus'];
			} else {
				$other_other_abnormal_fundus = '';
			}
			if (isset ( $_POST ['oculomotor_nystagmus'] )) {
				$oculomotor_nystagmus = $_POST ['oculomotor_nystagmus'];
			} else {
				$oculomotor_nystagmus = '';
			}
			if (isset ( $_POST ['describe_oculomotor_nystagmus'] )) {
				$describe_oculomotor_nystagmus = $_POST ['describe_oculomotor_nystagmus'];
			} else {
				$describe_oculomotor_nystagmus = '';
			}
			if (isset ( $_POST ['oculomotor_saccadic_pursuit'] )) {
				$oculomotor_saccadic_pursuit = $_POST ['oculomotor_saccadic_pursuit'];
			} else {
				$oculomotor_saccadic_pursuit = '';
			}
			if (isset ( $_POST ['describe_oculomotor_saccadic_pursuit'] )) {
				$describe_oculomotor_saccadic_pursuit = $_POST ['describe_oculomotor_saccadic_pursuit'];
			} else {
				$describe_oculomotor_saccadic_pursuit = '';
			}
			if (isset ( $_POST ['oculomotor_fixation_instability'] )) {
				$oculomotor_fixation_instability = $_POST ['oculomotor_fixation_instability'];
			} else {
				$oculomotor_fixation_instability = '';
			}
			if (isset ( $_POST ['describe_oculomotor_fixation_instability'] )) {
				$describe_oculomotor_fixation_instability = $_POST ['describe_oculomotor_fixation_instability'];
			} else {
				$describe_oculomotor_fixation_instability = '';
			}
			if (isset ( $_POST ['vertical_oculomotor_slow_saccades'] )) {
				$vertical_oculomotor_slow_saccades = $_POST ['vertical_oculomotor_slow_saccades'];
			} else {
				$vertical_oculomotor_slow_saccades = '';
			}
			if (isset ( $_POST ['describe_vertical_oculomotor_slow_saccades'] )) {
				$describe_vertical_oculomotor_slow_saccades = $_POST ['describe_vertical_oculomotor_slow_saccades'];
			} else {
				$describe_vertical_oculomotor_slow_saccades = '';
			}
			if (isset ( $_POST ['horizontal_oculomotor_slow_saccades'] )) {
				$horizontal_oculomotor_slow_saccades = $_POST ['horizontal_oculomotor_slow_saccades'];
			} else {
				$horizontal_oculomotor_slow_saccades = '';
			}
			if (isset ( $_POST ['describe_horizontal_oculomotor_slow_saccades'] )) {
				$describe_horizontal_oculomotor_slow_saccades = $_POST ['describe_horizontal_oculomotor_slow_saccades'];
			} else {
				$describe_horizontal_oculomotor_slow_saccades = '';
			}
			if (isset ( $_POST ['oculomotor_motor_apraxia'] )) {
				$oculomotor_motor_apraxia = $_POST ['oculomotor_motor_apraxia'];
			} else {
				$oculomotor_motor_apraxia = '';
			}
			if (isset ( $_POST ['describe_oculomotor_motor_apraxia'] )) {
				$describe_oculomotor_motor_apraxia = $_POST ['describe_oculomotor_motor_apraxia'];
			} else {
				$describe_oculomotor_motor_apraxia = '';
			}
			if (isset ( $_POST ['oculomotor_vertical_ophtalmoplegia'] )) {
				$oculomotor_vertical_ophtalmoplegia = $_POST ['oculomotor_vertical_ophtalmoplegia'];
			} else {
				$oculomotor_vertical_ophtalmoplegia = '';
			}
			if (isset ( $_POST ['describe_oculomotor_vertical_ophtalmoplegia'] )) {
				$describe_oculomotor_vertical_ophtalmoplegia = $_POST ['describe_oculomotor_vertical_ophtalmoplegia'];
			} else {
				$describe_oculomotor_vertical_ophtalmoplegia = '';
			}
			if (isset ( $_POST ['oculomotor_horizontal_ophtalmoplegia'] )) {
				$oculomotor_horizontal_ophtalmoplegia = $_POST ['oculomotor_horizontal_ophtalmoplegia'];
			} else {
				$oculomotor_horizontal_ophtalmoplegia = '';
			}
			if (isset ( $_POST ['describe_oculomotor_horizontal_ophtalmoplegia'] )) {
				$describe_oculomotor_horizontal_ophtalmoplegia = $_POST ['describe_oculomotor_horizontal_ophtalmoplegia'];
			} else {
				$describe_oculomotor_horizontal_ophtalmoplegia = '';
			}
			
			if (isset ( $_POST ['intellectual_deterioration'] )) {
				$intellectual_deterioration = $_POST ['intellectual_deterioration'];
			} else {
				$intellectual_deterioration = '';
			}
			if (isset ( $_POST ['intellectual_deterioration_age'] )) {
				$intellectual_deterioration_age = $_POST ['intellectual_deterioration_age'];
			} else {
				$intellectual_deterioration_age = '';
			}
			if (isset ( $_POST ['intellectual_deterioration_type'] )) {
				$intellectual_deterioration_type = $_POST ['intellectual_deterioration_type'];
			} else {
				$intellectual_deterioration_type = '';
			}
			if (isset ( $_POST ['mental_retardation'] )) {
				$mental_retardation = $_POST ['mental_retardation'];
			} else {
				$mental_retardation = '';
			}
			if (isset ( $_POST ['mental_retardation_age'] )) {
				$mental_retardation_age = $_POST ['mental_retardation_age'];
			} else {
				$mental_retardation_age = '';
			}
			if (isset ( $_POST ['mental_retardation_type'] )) {
				$mental_retardation_type = $_POST ['mental_retardation_type'];
			} else {
				$mental_retardation_type = '';
			}
			if (isset ( $_POST ['psychiatric_symptoms'] )) {
				$psychiatric_symptoms = $_POST ['psychiatric_symptoms'];
			} else {
				$psychiatric_symptoms = '';
			}
			if (isset ( $_POST ['describe_psychiatric_symptoms'] )) {
				$describe_psychiatric_symptoms = $_POST ['describe_psychiatric_symptoms'];
			} else {
				$describe_psychiatric_symptoms = '';
			}
			
			if (isset ( $_POST ['unsteadiness'] )) {
				$unsteadiness = $_POST ['unsteadiness'];
			} else {
				$unsteadiness = '';
			}
			if (isset ( $_POST ['dysphagia'] )) {
				$dysphagia = $_POST ['dysphagia'];
			} else {
				$dysphagia = '';
			}
			if (isset ( $_POST ['age_dysphagia'] )) {
				$age_dysphagia = $_POST ['age_dysphagia'];
			} else {
				$age_dysphagia = '';
			}
			// ~ if(isset($_POST['describe_dysphagia'])){ $describe_dysphagia = $_POST['describe_dysphagia']; }else{ $describe_dysphagia = '';}
			if (isset ( $_POST ['dysphagia_severity'] )) {
				$dysphagia_severity = $_POST ['dysphagia_severity'];
			} else {
				$dysphagia_severity = '';
			}
			if (isset ( $_POST ['skin_problems'] )) {
				$skin_problems = $_POST ['skin_problems'];
			} else {
				$skin_problems = '';
			}
			if (isset ( $_POST ['describe_skin_problems'] )) {
				$describe_skin_problems = $_POST ['describe_skin_problems'];
			} else {
				$describe_skin_problems = '';
			}
			if (isset ( $_POST ['hearing_impairment'] )) {
				$hearing_impairment = $_POST ['hearing_impairment'];
			} else {
				$hearing_impairment = '';
			}
			if (isset ( $_POST ['describe_hearing_impairment'] )) {
				$describe_hearing_impairment = $_POST ['describe_hearing_impairment'];
			} else {
				$describe_hearing_impairment = '';
			}
			if (isset ( $_POST ['epilepsy'] )) {
				$epilepsy = $_POST ['epilepsy'];
			} else {
				$epilepsy = '';
			}
			if (isset ( $_POST ['epilepsy_age'] )) {
				$epilepsy_age = $_POST ['epilepsy_age'];
			} else {
				$epilepsy_age = '';
			}
			if (isset ( $_POST ['epilepsy_type'] )) {
				$epilepsy_type = $_POST ['epilepsy_type'];
			} else {
				$epilepsy_type = '';
			}
			
			if (isset ( $_POST ['other_medical_complaints'] )) {
				$other_medical_complaints = $_POST ['other_medical_complaints'];
			} else {
				$other_medical_complaints = '';
			}
			
			if (isset ( $_POST ['score_SARA'] )) {
				$score_SARA = $_POST ['score_SARA'];
			} else {
				$score_SARA = '';
			}
			// ~ if(isset($_POST['score_SPRS'])){ $score_SPRS = $_POST['score_SPRS']; }else{ $score_SPRS = '';}
			if (isset ( $_POST ['score_CCFS'] )) {
				$score_CCFS = $_POST ['score_CCFS'];
			} else {
				$score_CCFS = '';
			}
			// ~ if(isset($_POST['score_OPYNOV'])){ $score_OPYNOV = $_POST['score_OPYNOV']; }else{ $score_OPYNOV = '';}
			if (isset ( $_POST ['board_number'] )) {
				$board_number = $_POST ['board_number'];
			} else {
				$board_number = '';
			}
			if (isset ( $_POST ['exam_number'] )) {
				$exam_number = $_POST ['exam_number'];
			} else {
				$exam_number = '';
			}
			if (isset ( $_POST ['half_score'] )) {
				$half_score = $_POST ['half_score'];
			} else {
				$half_score = '';
			}
			if (isset ( $_POST ['full_score'] )) {
				$full_score = $_POST ['full_score'];
			} else {
				$full_score = '';
			}
			// ~ if(isset($_POST['score_25FAT'])){ $score_25FAT = $_POST['score_25FAT']; }else{ $score_25FAT = '';}
			if (isset ( $_POST ['score_UHDRS'] )) {
				$score_UHDRS = $_POST ['score_UHDRS'];
			} else {
				$score_UHDRS = '';
			}
			// ~ if(isset($_POST['score_AMBUS'])){ $score_AMBUS = $_POST['score_AMBUS']; }else{ $score_AMBUS = '';}
			
			if (isset ( $_POST ['diagnostic_type_ataxia'] ) and $_POST ['diagnostic_type_ataxia'] != '') {
				$diagnostic_type_ataxia = $_POST ['diagnostic_type_ataxia'];
				if (is_array ( $_POST ['diagnostic_type_ataxia'] )) {
					$diagnostic_type_ataxia = implode ( ', ', $_POST ['diagnostic_type_ataxia'] );
				}
			} else {
				$diagnostic_type_ataxia = '';
			}
			if (isset ( $_POST ['diagnostic_type_ps'] ) and $_POST ['diagnostic_type_ps'] != '') {
				$diagnostic_type_ps = $_POST ['diagnostic_type_ps'];
				if (is_array ( $_POST ['diagnostic_type_ps'] )) {
					$diagnostic_type_ps = implode ( ', ', $_POST ['diagnostic_type_ps'] );
				}
			} else {
				$diagnostic_type_ps = '';
			}
			if (isset ( $_POST ['diagnostic_cerebellar_ataxia_type'] )) {
				$diagnostic_cerebellar_ataxia_type = $_POST ['diagnostic_cerebellar_ataxia_type'];
			} else {
				$diagnostic_cerebellar_ataxia_type = '';
			}
			if (isset ( $_POST ['diagnostic_cerebellar_ataxia_form'] )) {
				$diagnostic_cerebellar_ataxia_form = $_POST ['diagnostic_cerebellar_ataxia_form'];
			} else {
				$diagnostic_cerebellar_ataxia_form = '';
			}
			if (isset ( $_POST ['diagnostic_cerebellar_ataxia_affection'] )) {
				$diagnostic_cerebellar_ataxia_affection = $_POST ['diagnostic_cerebellar_ataxia_affection'];
			} else {
				$diagnostic_cerebellar_ataxia_affection = '';
			}
			
			if (isset ( $_POST ['diagnostic_spastic_parapesis_type'] )) {
				$diagnostic_spastic_parapesis_type = $_POST ['diagnostic_spastic_parapesis_type'];
			} else {
				$diagnostic_spastic_parapesis_type = '';
			}
			if (isset ( $_POST ['diagnostic_spastic_parapesis_form'] )) {
				$diagnostic_spastic_parapesis_form = $_POST ['diagnostic_spastic_parapesis_form'];
			} else {
				$diagnostic_spastic_parapesis_form = '';
			}
			if (isset ( $_POST ['diagnostic_spastic_parapesis_affection'] )) {
				$diagnostic_spastic_parapesis_affection = $_POST ['diagnostic_spastic_parapesis_affection'];
			} else {
				$diagnostic_spastic_parapesis_affection = '';
			}
			
			if (isset ( $_POST ['cerebral_mri'] )) {
				$cerebral_mri = $_POST ['cerebral_mri'];
			} else {
				$cerebral_mri = '';
			}
			if (isset ( $_POST ['cerebral_mri_cerebrum_specify'] )) {
				$cerebral_mri_cerebrum_specify = $_POST ['cerebral_mri_cerebrum_specify'];
			} else {
				$cerebral_mri_cerebrum_specify = '';
			}
			if (isset ( $_POST ['cerebral_mri_cerebellum_specify'] )) {
				$cerebral_mri_cerebellum_specify = $_POST ['cerebral_mri_cerebellum_specify'];
			} else {
				$cerebral_mri_cerebellum_specify = '';
			}
			if (isset ( $_POST ['cerebral_mri_brainstem_specify'] )) {
				$cerebral_mri_brainstem_specify = $_POST ['cerebral_mri_brainstem_specify'];
			} else {
				$cerebral_mri_brainstem_specify = '';
			}
			if (isset ( $_POST ['cerebral_mri_corpus_callosum_specify'] )) {
				$cerebral_mri_corpus_callosum_specify = $_POST ['cerebral_mri_corpus_callosum_specify'];
			} else {
				$cerebral_mri_corpus_callosum_specify = '';
			}
			if (isset ( $_POST ['cerebral_mri_upper_spinal_cord_specify'] )) {
				$cerebral_mri_upper_spinal_cord_specify = $_POST ['cerebral_mri_upper_spinal_cord_specify'];
			} else {
				$cerebral_mri_upper_spinal_cord_specify = '';
			}
			if (isset ( $_POST ['white_matter_mri_cerebrum_specify'] )) {
				$white_matter_mri_cerebrum_specify = $_POST ['white_matter_mri_cerebrum_specify'];
			} else {
				$white_matter_mri_cerebrum_specify = '';
			}
			if (isset ( $_POST ['white_matter_mri_cerebellum_specify'] )) {
				$white_matter_mri_cerebellum_specify = $_POST ['white_matter_mri_cerebellum_specify'];
			} else {
				$white_matter_mri_cerebellum_specify = '';
			}
			if (isset ( $_POST ['white_matter_mri_brainstem_specify'] )) {
				$white_matter_mri_brainstem_specify = $_POST ['white_matter_mri_brainstem_specify'];
			} else {
				$white_matter_mri_brainstem_specify = '';
			}
			if (isset ( $_POST ['white_matter_mri_corpus_callosum_specify'] )) {
				$white_matter_mri_corpus_callosum_specify = $_POST ['white_matter_mri_corpus_callosum_specify'];
			} else {
				$white_matter_mri_corpus_callosum_specify = '';
			}
			if (isset ( $_POST ['white_matter_mri_upper_spinal_cord_specify'] )) {
				$white_matter_mri_upper_spinal_cord_specify = $_POST ['white_matter_mri_upper_spinal_cord_specify'];
			} else {
				$white_matter_mri_upper_spinal_cord_specify = '';
			}
			
			if (isset ( $_POST ['medullar_mri'] )) {
				$medullar_mri = $_POST ['medullar_mri'];
			} else {
				$medullar_mri = '';
			}
			
			// ~ if(isset($_POST['emg_ncv_ul'])){ $emg_ncv_ul = $_POST['emg_ncv_ul']; }else{ $emg_ncv_ul = '';}
			// ~ if(isset($_POST['emg_ncv_ul_specify'])){ $emg_ncv_ul_specify = $_POST['emg_ncv_ul_specify']; }else{ $emg_ncv_ul_specify = '';}
			// ~ if(isset($_POST['emg_ncv_ll'])){ $emg_ncv_ll = $_POST['emg_ncv_ll']; }else{ $emg_ncv_ll = '';}
			// ~ if(isset($_POST['emg_ncv_ll_specify'])){ $emg_ncv_ll_specify = $_POST['emg_ncv_ll_specify']; }else{ $emg_ncv_ll_specify = '';}
			if (isset ( $_POST ['polyneuropathy'] )) {
				$polyneuropathy = $_POST ['polyneuropathy'];
			} else {
				$polyneuropathy = '';
			}
			if (isset ( $_POST ['polyneuropathy_specify'] )) {
				$polyneuropathy_specify = $_POST ['polyneuropathy_specify'];
			} else {
				$polyneuropathy_specify = '';
			}
			if (isset ( $_POST ['polyneuropathy_other'] )) {
				$polyneuropathy_other = $_POST ['polyneuropathy_other'];
			} else {
				$polyneuropathy_other = '';
			}
			if (isset ( $_POST ['vep'] )) {
				$vep = $_POST ['vep'];
			} else {
				$vep = '';
			}
			if (isset ( $_POST ['vep_specify'] )) {
				$vep_specify = $_POST ['vep_specify'];
			} else {
				$vep_specify = '';
			}
			if (isset ( $_POST ['aep'] )) {
				$aep = $_POST ['aep'];
			} else {
				$aep = '';
			}
			if (isset ( $_POST ['aep_specify'] )) {
				$aep_specify = $_POST ['aep_specify'];
			} else {
				$aep_specify = '';
			}
			if (isset ( $_POST ['mep'] )) {
				$mep = $_POST ['mep'];
			} else {
				$mep = '';
			}
			if (isset ( $_POST ['mep_specify'] )) {
				$mep_specify = $_POST ['mep_specify'];
			} else {
				$mep_specify = '';
			}
			if (isset ( $_POST ['sep'] )) {
				$sep = $_POST ['sep'];
			} else {
				$sep = '';
			}
			if (isset ( $_POST ['sep_specify'] )) {
				$sep_specify = $_POST ['sep_specify'];
			} else {
				$sep_specify = '';
			}
			
			if (isset ( $_POST ['albumin'] )) {
				$albumin = $_POST ['albumin'];
			} else {
				$albumin = '';
			}
			if (isset ( $_POST ['albumin_specify'] )) {
				$albumin_specify = $_POST ['albumin_specify'];
			} else {
				$albumin_specify = '';
			}
			if (isset ( $_POST ['alphafoetoprotein'] )) {
				$alphafoetoprotein = $_POST ['alphafoetoprotein'];
			} else {
				$alphafoetoprotein = '';
			}
			if (isset ( $_POST ['alphafoetoprotein_specify'] )) {
				$alphafoetoprotein_specify = $_POST ['alphafoetoprotein_specify'];
			} else {
				$alphafoetoprotein_specify = '';
			}
			if (isset ( $_POST ['cholestanol'] )) {
				$cholestanol = $_POST ['cholestanol'];
			} else {
				$cholestanol = '';
			}
			if (isset ( $_POST ['cholestanol_specify'] )) {
				$cholestanol_specify = $_POST ['cholestanol_specify'];
			} else {
				$cholestanol_specify = '';
			}
			if (isset ( $_POST ['cholesterol'] )) {
				$cholesterol = $_POST ['cholesterol'];
			} else {
				$cholesterol = '';
			}
			if (isset ( $_POST ['cholesterol_specify'] )) {
				$cholesterol_specify = $_POST ['cholesterol_specify'];
			} else {
				$cholesterol_specify = '';
			}
			if (isset ( $_POST ['_25OHcholesterol'] )) {
				$_25OHcholesterol = $_POST ['_25OHcholesterol'];
			} else {
				$_25OHcholesterol = '';
			}
			if (isset ( $_POST ['_25OHcholesterol_specify'] )) {
				$_25OHcholesterol_specify = $_POST ['_25OHcholesterol_specify'];
			} else {
				$_25OHcholesterol_specify = '';
			}
			if (isset ( $_POST ['_27OHcholesterol'] )) {
				$_27OHcholesterol = $_POST ['_27OHcholesterol'];
			} else {
				$_27OHcholesterol = '';
			}
			if (isset ( $_POST ['_27OHcholesterol_specify'] )) {
				$_27OHcholesterol_specify = $_POST ['_27OHcholesterol_specify'];
			} else {
				$_27OHcholesterol_specify = '';
			}
			if (isset ( $_POST ['vlcfa'] )) {
				$vlcfa = $_POST ['vlcfa'];
			} else {
				$vlcfa = '';
			}
			if (isset ( $_POST ['vlcfa_specify'] )) {
				$vlcfa_specify = $_POST ['vlcfa_specify'];
			} else {
				$vlcfa_specify = '';
			}
			if (isset ( $_POST ['other_biology'] )) {
				$other_biology = $_POST ['other_biology'];
			} else {
				$other_biology = '';
			}
			if (isset ( $_POST ['other_biology_specify'] )) {
				$other_biology_specify = $_POST ['other_biology_specify'];
			} else {
				$other_biology_specify = '';
			}
			
			if (isset ( $_POST ['serum_protein_electrophoresis'] )) {
				$serum_protein_electrophoresis = $_POST ['serum_protein_electrophoresis'];
			} else {
				$serum_protein_electrophoresis = '';
			}
			if (isset ( $_POST ['serum_protein_electrophoresis_specify'] )) {
				$serum_protein_electrophoresis_specify = $_POST ['serum_protein_electrophoresis_specify'];
			} else {
				$serum_protein_electrophoresis_specify = '';
			}
			if (isset ( $_POST ['vitamin_E'] )) {
				$vitamin_E = $_POST ['vitamin_E'];
			} else {
				$vitamin_E = '';
			}
			if (isset ( $_POST ['vitamin_E_specify'] )) {
				$vitamin_E_specify = $_POST ['vitamin_E_specify'];
			} else {
				$vitamin_E_specify = '';
			}
			if (isset ( $_POST ['apolipoprotein_AB'] )) {
				$apolipoprotein_AB = $_POST ['apolipoprotein_AB'];
			} else {
				$apolipoprotein_AB = '';
			}
			if (isset ( $_POST ['apolipoprotein_AB_specify'] )) {
				$apolipoprotein_AB_specify = $_POST ['apolipoprotein_AB_specify'];
			} else {
				$apolipoprotein_AB_specify = '';
			}
			// ~ if(isset($_POST['muscle_biopsy'])){ $muscle_biopsy = $_POST['muscle_biopsy']; }else{ $muscle_biopsy = '';}
			// ~ if(isset($_POST['muscle_biopsy_specify'])){ $muscle_biopsy_specify = $_POST['muscle_biopsy_specify']; }else{ $muscle_biopsy_specify = '';}
			// ~ if(isset($_POST['skin_biopsy'])){ $skin_biopsy = $_POST['skin_biopsy']; }else{ $skin_biopsy = '';}
			// ~ if(isset($_POST['skin_biopsy_specify'])){ $skin_biopsy_specify = $_POST['skin_biopsy_specify']; }else{ $skin_biopsy_specify = '';}
			// ~ if(isset($_POST['erg'])){ $erg = $_POST['erg']; }else{ $erg = '';}
			// ~ if(isset($_POST['erg_specify'])){ $erg_specify = $_POST['erg_specify']; }else{ $erg_specify = '';}
			// ~ if(isset($_POST['fundus_examination'])){ $fundus_examination = $_POST['fundus_examination']; }else{ $fundus_examination = '';}
			// ~ if(isset($_POST['fundus_examination_specify'])){ $fundus_examination_specify = $_POST['fundus_examination_specify']; }else{ $fundus_examination_specify = '';}
			// ~ if(isset($_POST['iq'])){ $iq = $_POST['iq']; }else{ $iq = '';}
			// ~ if(isset($_POST['iq_value'])){ $iq_value = $_POST['iq_value']; }else{ $iq_value = '';}
			// ~ if(isset($_POST['urodynamics'])){ $urodynamics = $_POST['urodynamics']; }else{ $urodynamics = '';}
			// ~ if(isset($_POST['urodynamics_specify'])){ $urodynamics_specify = $_POST['urodynamics_specify']; }else{ $urodynamics_specify = '';}
			// ~ if(isset($_POST['urine_density'])){ $urine_density = $_POST['urine_density']; }else{ $urine_density = '';}
			// ~ if(isset($_POST['urine_density_specify'])){ $urine_density_specify = $_POST['urine_density_specify']; }else{ $urine_density_specify = '';}
			
			if (isset ( $_POST ['dna'] )) {
				$dna = $_POST ['dna'];
			} else {
				$dna = '';
			}
			if (isset ( $_POST ['nbia'] )) {
				$nbia = $_POST ['nbia'];
			} else {
				$nbia = '';
			}
			if (isset ( $_POST ['cerebellar_mri_other'] )) {
				$cerebellar_mri_other = $_POST ['cerebellar_mri_other'];
			} else {
				$cerebellar_mri_other = '';
			}
			if (isset ( $_POST ['immortalized_cell_lines'] )) {
				$immortalized_cell_lines = $_POST ['immortalized_cell_lines'];
			} else {
				$immortalized_cell_lines = '';
			}
			if (isset ( $_POST ['muscle_tissue'] )) {
				$muscle_tissue = $_POST ['muscle_tissue'];
			} else {
				$muscle_tissue = '';
			}
			if (isset ( $_POST ['stored_skin_biopsy'] )) {
				$stored_skin_biopsy = $_POST ['stored_skin_biopsy'];
			} else {
				$stored_skin_biopsy = '';
			}
			// ~ if(isset($_POST['nerve_biopsy'])){ $nerve_biopsy = $_POST['nerve_biopsy']; }else{ $nerve_biopsy = '';}
			// ~ if(isset($_POST['other_stored_material'])){ $other_stored_material = $_POST['other_stored_material']; }else{ $other_stored_material = '';}
			
			if (isset ( $_FILES ['fichieraajouter'] ) and $_FILES ['fichieraajouter'] ['error'] == 0) {
				$tabledate = getdate ();
				$id_unique = $tabledate ['seconds'] . $tabledate ['minutes'] . $tabledate ['hours'] . $tabledate ['mday'] . $tabledate ['mon'] . $tabledate ['year'];
				move_uploaded_file ( $_FILES ['fichieraajouter'] ['tmp_name'], '../uploads/' . $id_unique . '_' . basename ( $_FILES ['fichieraajouter'] ['name'] ) );
				// ~ echo $_FILES['fichieraajouter']['tmp_name'] . " et ".'../uploads/'.$id_unique.'_'. basename($_FILES['fichieraajouter']['name']);
				chmod ( '../uploads/' . $id_unique . '_' . basename ( $_FILES ['fichieraajouter'] ['name'] ), 0777 );
				$fichiersattaches .= $id_unique . '_' . basename ( $_FILES ['fichieraajouter'] ['name'] ) . ";";
			}
			
			require_once ("./requetes/remplissage_form.php");
		} elseif (isset ( $_GET ['from'] ) and $_GET ['from'] == 'sara') {
			$score_SARA = $_POST ['gait'] + $_POST ['stance'] + $_POST ['sitting'] + $_POST ['speech'] + $_POST ['scorefingerchase'] + $_POST ['scorenosefinger'] + $_POST ['scorehandmovements'] + $_POST ['scoreheelshin'];
			require_once ("./requetes/remplissage_score_SARA.php");
			
			// ~ }elseif(isset($_GET['from']) and $_GET['from'] == 'sprs'){
			// ~ $score_SPRS = $_POST['walk']+$_POST['gait']+$_POST['gait_speed']+$_POST['climb']+$_POST['climb_speed']+$_POST['rise']+$_POST['spas_hip']+$_POST['spas_knee']+$_POST['weakness_hip'] +$_POST['weakness_foot']+$_POST['lowerlimbs']+$_POST['relatedsymptoms']+$_POST['BBfunction'];
			// ~
			// ~ require_once("./requetes/remplissage_score_SPRS.php");
			// ~ }elseif(isset($_GET['from']) and $_GET['from'] == '25fat'){
			// ~ $score_25FAT = $_POST['score_25FAT'];
			// ~ require_once("./requetes/remplissage_score_25FAT.php");
			// ~
			// ~ }elseif(isset($_GET['from']) and $_GET['from'] == 'ccfs'){
			// ~
			// require_once("./requetes/remplissage_score_CCFS.php"); // pour pallier au fait qu'on envoie pas la variable par POST
			// ~ $score_CCFS = $_SESSION['score_CCFS'];
			// ~
		} elseif (isset ( $_GET ['from'] ) and $_GET ['from'] == 'uhdrs') {
			$score_UHDRS = $_SESSION ['score_UHDRS'];
			require_once ("./requetes/remplissage_score_UHDRS.php");
		}
		// ~ elseif(isset($_GET['from']) and $_GET['from'] == 'ambus'){
		// ~ $score_AMBUS = $_POST['ambus_without_help'] + $_POST['ambus_with_help'];
		// ~ require_once("./requetes/remplissage_score_AMBUS.php");
		// ~
		// ~ }
		
		require ("./requetes/remplissage_questionnaire.php"); // permet de créer $hash_champ_valeur pour le remplissage des champs du questionnaire
		                                                      // ~ print_r($hash_champ_valeur);
		                                                      
		// récupération de la valeur des champs "radio"
		if (strstr ( $hash_champ_valeur ['proband'], 'yes' )) {
			$check_proband_yes = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['proband'], 'no' )) {
			$check_proband_no = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['sex'], 'female' )) {
			$check_sex_female = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['sex'], 'male' )) {
			$check_sex_male = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['initialexam'], 'yes' )) {
			$check_initialexam_yes = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['initialexam'], 'no' )) {
			$check_initialexam_no = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['ps_or_ataxia_in_family'], 'yes' )) {
			$check_ps_or_ataxia_in_family_yes = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ps_or_ataxia_in_family'], 'no' )) {
			$check_ps_or_ataxia_in_family_no = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['other_familial_disease'], 'yes' )) {
			$check_other_familial_disease_yes = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['other_familial_disease'], 'no' )) {
			$check_other_familial_disease_no = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['consanguinity'], 'yes' )) {
			$check_consanguinity_yes = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['consanguinity'], 'no' )) {
			$check_consanguinity_no = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['parental_inheritance'], 'paternal' )) {
			$check_parental_inheritance_paternal = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['parental_inheritance'], 'maternal' )) {
			$check_parental_inheritance_maternal = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['motor_development'], 'normal' )) {
			$check_motor_development_normal = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_development'], 'delayed' )) {
			$check_motor_development_delayed = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['intellect_development'], 'normal' )) {
			$check_intellect_development_normal = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['intellect_development'], 'delayed' )) {
			$check_intellect_development_delayed = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['unsteadiness'], 'yes' )) {
			$check_unsteadiness_yes = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['unsteadiness'], 'no' )) {
			$check_unsteadiness_no = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['dysarthria'], 'yes' )) {
			$check_dysarthria_yes = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['dysarthria'], 'no' )) {
			$check_dysarthria_no = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['stiff_legs'], 'yes' )) {
			$check_stiff_legs_yes = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['stiff_legs'], 'no' )) {
			$check_stiff_legs_no = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['cramps'], 'yes' )) {
			$check_cramps_yes = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['cramps'], 'no' )) {
			$check_cramps_no = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['medical_exam'], 'yes' )) {
			$check_medical_exam_yes = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['medical_exam'], 'no' )) {
			$check_medical_exam_no = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['pain'], 'yes' )) {
			$check_pain_yes = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['pain'], 'no' )) {
			$check_pain_no = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['diplopia_at_onset'], 'yes' )) {
			$check_diplopia_at_onset_yes = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['diplopia_at_onset'], 'no' )) {
			$check_diplopia_at_onset_no = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['other_signs_onset'], 'yes' )) {
			$check_other_signs_onset_yes = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['other_signs_onset'], 'no' )) {
			$check_other_signs_onset_no = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['spasticity_upper_limbs'], 'none' )) {
			$check_spasticity_upper_limbs_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['spasticity_upper_limbs'], 'mild' )) {
			$check_spasticity_upper_limbs_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['spasticity_upper_limbs'], 'moderate' )) {
			$check_spasticity_upper_limbs_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['spasticity_upper_limbs'], 'severe' )) {
			$check_spasticity_upper_limbs_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['ataxia_upper_limbs'], 'none' )) {
			$check_ataxia_upper_limbs_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ataxia_upper_limbs'], 'mild' )) {
			$check_ataxia_upper_limbs_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ataxia_upper_limbs'], 'moderate' )) {
			$check_ataxia_upper_limbs_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ataxia_upper_limbs'], 'severe' )) {
			$check_ataxia_upper_limbs_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['spasticity_lower_limbs'], 'none' )) {
			$check_spasticity_lower_limbs_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['spasticity_lower_limbs'], 'mild' )) {
			$check_spasticity_lower_limbs_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['spasticity_lower_limbs'], 'moderate' )) {
			$check_spasticity_lower_limbs_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['spasticity_lower_limbs'], 'severe' )) {
			$check_spasticity_lower_limbs_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['ataxia_lower_limbs'], 'none' )) {
			$check_ataxia_lower_limbs_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ataxia_lower_limbs'], 'mild' )) {
			$check_ataxia_lower_limbs_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ataxia_lower_limbs'], 'moderate' )) {
			$check_ataxia_lower_limbs_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ataxia_lower_limbs'], 'severe' )) {
			$check_ataxia_lower_limbs_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['spasticity_gait'], 'none' )) {
			$check_spasticity_gait_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['spasticity_gait'], 'mild' )) {
			$check_spasticity_gait_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['spasticity_gait'], 'moderate' )) {
			$check_spasticity_gait_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['spasticity_gait'], 'severe' )) {
			$check_spasticity_gait_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['ataxia_gait'], 'none' )) {
			$check_ataxia_gait_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ataxia_gait'], 'mild' )) {
			$check_ataxia_gait_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ataxia_gait'], 'moderate' )) {
			$check_ataxia_gait_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ataxia_gait'], 'severe' )) {
			$check_ataxia_gait_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['spasticity_dysarthria'], 'none' )) {
			$check_spasticity_dysarthria_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['spasticity_dysarthria'], 'mild' )) {
			$check_spasticity_dysarthria_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['spasticity_dysarthria'], 'moderate' )) {
			$check_spasticity_dysarthria_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['spasticity_dysarthria'], 'severe' )) {
			$check_spasticity_dysarthria_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['ataxia_dysarthria'], 'none' )) {
			$check_ataxia_dysarthria_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ataxia_dysarthria'], 'mild' )) {
			$check_ataxia_dysarthria_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ataxia_dysarthria'], 'moderate' )) {
			$check_ataxia_dysarthria_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ataxia_dysarthria'], 'severe' )) {
			$check_ataxia_dysarthria_severe = 'checked';
		}
		
		if ($hash_champ_valeur ['disability_stage'] == '0') {
			$check_disability_stage_0 = 'checked';
		} elseif ($hash_champ_valeur ['disability_stage'] == '1') {
			$check_disability_stage_1 = 'checked';
		} elseif ($hash_champ_valeur ['disability_stage'] == '2') {
			$check_disability_stage_2 = 'checked';
		} elseif ($hash_champ_valeur ['disability_stage'] == '3') {
			$check_disability_stage_3 = 'checked';
		} elseif ($hash_champ_valeur ['disability_stage'] == '4') {
			$check_disability_stage_4 = 'checked';
		} elseif ($hash_champ_valeur ['disability_stage'] == '5') {
			$check_disability_stage_5 = 'checked';
		} elseif ($hash_champ_valeur ['disability_stage'] == '6') {
			$check_disability_stage_6 = 'checked';
		} elseif ($hash_champ_valeur ['disability_stage'] == '7') {
			$check_disability_stage_7 = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['jaw_jerk'], 'normal' )) {
			$check_jaw_jerk_normal = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['jaw_jerk'], 'increased' )) {
			$check_jaw_jerk_increased = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['jaw_jerk'], 'diffused' )) {
			$check_jaw_jerk_diffused = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['jaw_jerk'], 'decreased' )) {
			$check_jaw_jerk_decreased = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['jaw_jerk'], 'absent' )) {
			$check_jaw_jerk_absent = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['jaw_jerk'], 'clonus' )) {
			$check_jaw_jerk_clonus = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['biceps'], 'normal' )) {
			$check_biceps_normal = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['biceps'], 'increased' )) {
			$check_biceps_increased = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['biceps'], 'diffused' )) {
			$check_biceps_diffused = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['biceps'], 'decreased' )) {
			$check_biceps_decreased = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['biceps'], 'absent' )) {
			$check_biceps_absent = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['biceps'], 'clonus' )) {
			$check_biceps_clonus = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['finger_flexor'], 'normal' )) {
			$check_finger_flexor_normal = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['finger_flexor'], 'increased' )) {
			$check_finger_flexor_increased = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['finger_flexor'], 'diffused' )) {
			$check_finger_flexor_diffused = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['finger_flexor'], 'decreased' )) {
			$check_finger_flexor_decreased = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['finger_flexor'], 'absent' )) {
			$check_finger_flexor_absent = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['finger_flexor'], 'clonus' )) {
			$check_finger_flexor_clonus = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['patellar'], 'normal' )) {
			$check_patellar_normal = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['patellar'], 'increased' )) {
			$check_patellar_increased = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['patellar'], 'diffused' )) {
			$check_patellar_diffused = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['patellar'], 'decreased' )) {
			$check_patellar_decreased = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['patellar'], 'absent' )) {
			$check_patellar_absent = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['patellar'], 'clonus' )) {
			$check_patellar_clonus = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['adductor'], 'normal' )) {
			$check_adductor_normal = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['adductor'], 'increased' )) {
			$check_adductor_increased = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['adductor'], 'diffused' )) {
			$check_adductor_diffused = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['adductor'], 'decreased' )) {
			$check_adductor_decreased = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['adductor'], 'absent' )) {
			$check_adductor_absent = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['adductor'], 'clonus' )) {
			$check_adductor_clonus = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['ankle'], 'normal' )) {
			$check_ankle_normal = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ankle'], 'increased' )) {
			$check_ankle_increased = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ankle'], 'diffused' )) {
			$check_ankle_diffused = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ankle'], 'decreased' )) {
			$check_ankle_decreased = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ankle'], 'absent' )) {
			$check_ankle_absent = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ankle'], 'clonus' )) {
			$check_ankle_clonus = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['hoffmans_sign'], 'absent' )) {
			$check_hoffmans_sign_absent = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['hoffmans_sign'], 'present' )) {
			$check_hoffmans_sign_present = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['plantar_reflex'], 'flexor' )) {
			$check_plantar_reflex_flexor = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['plantar_reflex'], 'indifferent' )) {
			$check_plantar_reflex_indifferent = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['plantar_reflex'], 'unilat' )) {
			$check_plantar_reflex_unilat = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['plantar_reflex'], 'bilat' )) {
			$check_plantar_reflex_bilat = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['plantar_reflex_right_left'], 'left' )) {
			$check_plantar_reflex_left = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['plantar_reflex_right_left'], 'right' )) {
			$check_plantar_reflex_right = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['motor_facial_palsy_atrophy'], 'none' )) {
			$check_motor_facial_palsy_atrophy_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_facial_palsy_atrophy'], 'mild' )) {
			$check_motor_facial_palsy_atrophy_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_facial_palsy_atrophy'], 'moderate' )) {
			$check_motor_facial_palsy_atrophy_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_facial_palsy_atrophy'], 'severe' )) {
			$check_motor_facial_palsy_atrophy_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['motor_proximal_UL'], 'none' )) {
			$check_motor_proximal_UL_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_proximal_UL'], 'mild' )) {
			$check_motor_proximal_UL_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_proximal_UL'], 'moderate' )) {
			$check_motor_proximal_UL_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_proximal_UL'], 'severe' )) {
			$check_motor_proximal_UL_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['motor_distal_UL'], 'none' )) {
			$check_motor_distal_UL_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_distal_UL'], 'mild' )) {
			$check_motor_distal_UL_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_distal_UL'], 'moderate' )) {
			$check_motor_distal_UL_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_distal_UL'], 'motor_severe' )) {
			$check_motor_distal_UL_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['motor_proximal_LL'], 'none' )) {
			$check_motor_proximal_LL_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_proximal_LL'], 'mild' )) {
			$check_motor_proximal_LL_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_proximal_LL'], 'moderate' )) {
			$check_motor_proximal_LL_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_proximal_LL'], 'severe' )) {
			$check_motor_proximal_LL_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['motor_distal_LL'], 'none' )) {
			$check_motor_distal_LL_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_distal_LL'], 'mild' )) {
			$check_motor_distal_LL_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_distal_LL'], 'moderate' )) {
			$check_motor_distal_LL_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['motor_distal_LL'], 'severe' )) {
			$check_motor_distal_LL_severe = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['muscle_proximal_UL'], 'none' )) {
			$check_muscle_proximal_UL_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['muscle_proximal_UL'], 'mild' )) {
			$check_muscle_proximal_UL_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['muscle_proximal_UL'], 'moderate' )) {
			$check_muscle_proximal_UL_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['muscle_proximal_UL'], 'severe' )) {
			$check_muscle_proximal_UL_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['muscle_distal_UL'], 'none' )) {
			$check_muscle_distal_UL_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['muscle_distal_UL'], 'mild' )) {
			$check_muscle_distal_UL_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['muscle_distal_UL'], 'moderate' )) {
			$check_muscle_distal_UL_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['muscle_distal_UL'], 'severe' )) {
			$check_muscle_distal_UL_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['muscle_proximal_LL'], 'none' )) {
			$check_muscle_proximal_LL_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['muscle_proximal_LL'], 'mild' )) {
			$check_muscle_proximal_LL_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['muscle_proximal_LL'], 'moderate' )) {
			$check_muscle_proximal_LL_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['muscle_proximal_LL'], 'severe' )) {
			$check_muscle_proximal_LL_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['muscle_distal_LL'], 'none' )) {
			$check_muscle_distal_LL_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['muscle_distal_LL'], 'mild' )) {
			$check_muscle_distal_LL_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['muscle_distal_LL'], 'moderate' )) {
			$check_muscle_distal_LL_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['muscle_distal_LL'], 'severe' )) {
			$check_muscle_distal_LL_severe = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['fasciculations'], 'no' )) {
			$check_fasciculations_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['fasciculations'], 'yes' )) {
			$check_fasciculations_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['myokymias'], 'no' )) {
			$check_myokymias_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['myokymias'], 'yes' )) {
			$check_myokymias_yes = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['vibration_sense'], 'none' )) {
			$check_vibration_sense_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['vibration_sense'], 'mild' )) {
			$check_vibration_sense_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['vibration_sense'], 'moderate' )) {
			$check_vibration_sense_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['vibration_sense'], 'severe' )) {
			$check_vibration_sense_severe = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['vibration_sense'], 'abolished' )) {
			$check_vibration_sense_abolished = 'checked';
		}
		// ~ if(strstr($hash_champ_valeur['superficial_sensory_loss'], 'no')){ $check_superficial_sensory_loss_no = 'checked';}elseif(strstr($hash_champ_valeur['superficial_sensory_loss'], 'touch')){ $check_superficial_sensory_loss_touch = 'checked';}elseif(strstr($hash_champ_valeur['superficial_sensory_loss'], 'prick')){ $check_superficial_sensory_loss_prick= 'checked';}elseif(strstr($hash_champ_valeur['superficial_sensory_loss'], 'cold')){ $check_superficial_sensory_loss_cold = 'checked';}
		
		if (strstr ( $hash_champ_valeur ['scoliosis'], 'none' )) {
			$check_scoliosis_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['scoliosis'], 'mild' )) {
			$check_scoliosis_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['scoliosis'], 'moderate' )) {
			$check_scoliosis_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['scoliosis'], 'severe' )) {
			$check_scoliosis_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['pes_cavus'], 'none' )) {
			$check_pes_cavus_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['pes_cavus'], 'mild' )) {
			$check_pes_cavus_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['pes_cavus'], 'moderate' )) {
			$check_pes_cavus_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['pes_cavus'], 'severe' )) {
			$check_pes_cavus_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['other_skeletal_abnormality'], 'none' )) {
			$check_other_skeletal_abnormality_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['other_skeletal_abnormality'], 'mild' )) {
			$check_other_skeletal_abnormality_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['other_skeletal_abnormality'], 'moderate' )) {
			$check_other_skeletal_abnormality_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['other_skeletal_abnormality'], 'severe' )) {
			$check_other_skeletal_abnormality_severe = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['facial_dysmorphia'], 'no' )) {
			$check_facial_dysmorphia_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['facial_dysmorphia'], 'yes' )) {
			$check_facial_dysmorphia_yes = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['urinary_urgency'], 'none' )) {
			$check_urinary_urgency_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['urinary_urgency'], 'mild' )) {
			$check_urinary_urgency_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['urinary_urgency'], 'moderate' )) {
			$check_urinary_urgency_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['urinary_urgency'], 'severe' )) {
			$check_urinary_urgency_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['urinary_incontinence'], 'none' )) {
			$check_urinary_incontinence_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['urinary_incontinence'], 'mild' )) {
			$check_urinary_incontinence_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['urinary_incontinence'], 'moderate' )) {
			$check_urinary_incontinence_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['urinary_incontinence'], 'severe' )) {
			$check_urinary_incontinence_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['urinary_retention'], 'none' )) {
			$check_urinary_retention_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['urinary_retention'], 'mild' )) {
			$check_urinary_retention_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['urinary_retention'], 'moderate' )) {
			$check_urinary_retention_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['urinary_retention'], 'severe' )) {
			$check_urinary_retention_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['anal_incontinence'], 'none' )) {
			$check_anal_incontinence_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['anal_incontinence'], 'mild' )) {
			$check_anal_incontinence_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['anal_incontinence'], 'moderate' )) {
			$check_anal_incontinence_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['anal_incontinence'], 'severe' )) {
			$check_anal_incontinence_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['impaired_sexual_function'], 'none' )) {
			$check_impaired_sexual_function_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['impaired_sexual_function'], 'mild' )) {
			$check_impaired_sexual_function_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['impaired_sexual_function'], 'moderate' )) {
			$check_impaired_sexual_function_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['impaired_sexual_function'], 'severe' )) {
			$check_impaired_sexual_function_severe = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['early_menopause'], 'yes' )) {
			$check_early_menopause_yes = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['early_menopause'], 'no' )) {
			$check_early_menopause_no = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['resting_tremor'], 'none' )) {
			$check_resting_tremor_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['resting_tremor'], 'mild' )) {
			$check_resting_tremor_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['resting_tremor'], 'moderate' )) {
			$check_resting_tremor_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['resting_tremor'], 'severe' )) {
			$check_resting_tremor_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['postural_tremor'], 'none' )) {
			$check_postural_tremor_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['postural_tremor'], 'mild' )) {
			$check_postural_tremor_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['postural_tremor'], 'moderate' )) {
			$check_postural_tremor_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['postural_tremor'], 'severe' )) {
			$check_postural_tremor_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['chorea'], 'none' )) {
			$check_chorea_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['chorea'], 'mild' )) {
			$check_chorea_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['chorea'], 'moderate' )) {
			$check_chorea_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['chorea'], 'severe' )) {
			$check_chorea_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['dystonia'], 'none' )) {
			$check_dystonia_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['dystonia'], 'mild' )) {
			$check_dystonia_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['dystonia'], 'moderate' )) {
			$check_dystonia_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['dystonia'], 'severe' )) {
			$check_dystonia_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['myoclonus'], 'none' )) {
			$check_myoclonus_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['myoclonus'], 'mild' )) {
			$check_myoclonus_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['myoclonus'], 'moderate' )) {
			$check_myoclonus_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['myoclonus'], 'severe' )) {
			$check_myoclonus_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['hypokinesia'], 'none' )) {
			$check_hypokinesia_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['hypokinesia'], 'mild' )) {
			$check_hypokinesia_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['hypokinesia'], 'moderate' )) {
			$check_hypokinesia_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['hypokinesia'], 'severe' )) {
			$check_hypokinesia_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['rigidity'], 'none' )) {
			$check_rigidity_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['rigidity'], 'mild' )) {
			$check_rigidity_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['rigidity'], 'moderate' )) {
			$check_rigidity_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['rigidity'], 'severe' )) {
			$check_rigidity_severe = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['diplopia'], 'no' )) {
			$check_diplopia_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['diplopia'], 'yes' )) {
			$check_diplopia_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['ptosis'], 'no' )) {
			$check_ptosis_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['ptosis'], 'yes' )) {
			$check_ptosis_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['bulging_eyes'], 'no' )) {
			$check_bulging_eyes_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['bulging_eyes'], 'yes' )) {
			$check_bulging_eyes_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['diminished_visual_acuity'], 'no' )) {
			$check_diminished_visual_acuity_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['diminished_visual_acuity'], 'yes' )) {
			$check_diminished_visual_acuity_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['abnormal_fundus'], 'no' )) {
			$check_abnormal_fundus_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['abnormal_fundus'], 'yes' )) {
			$check_abnormal_fundus_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['other_abnormal_fundus'], 'optic_atrophy' )) {
			$check_other_abnormal_fundus_optic_atrophy = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['other_abnormal_fundus'], 'retinis_pigmentosa' )) {
			$check_other_abnormal_fundus_Retinis_Pigmentosa = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['oculomotor_nystagmus'], 'no' )) {
			$check_oculomotor_nystagmus_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['oculomotor_nystagmus'], 'yes' )) {
			$check_oculomotor_nystagmus_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['oculomotor_saccadic_pursuit'], 'no' )) {
			$check_oculomotor_saccadic_pursuit_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['oculomotor_saccadic_pursuit'], 'yes' )) {
			$check_oculomotor_saccadic_pursuit_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['oculomotor_fixation_instability'], 'no' )) {
			$check_oculomotor_fixation_instability_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['oculomotor_fixation_instability'], 'yes' )) {
			$check_oculomotor_fixation_instability_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['vertical_oculomotor_slow_saccades'], 'no' )) {
			$check_vertical_oculomotor_slow_saccades_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['vertical_oculomotor_slow_saccades'], 'yes' )) {
			$check_vertical_oculomotor_slow_saccades_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['horizontal_oculomotor_slow_saccades'], 'no' )) {
			$check_horizontal_oculomotor_slow_saccades_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['horizontal_oculomotor_slow_saccades'], 'yes' )) {
			$check_horizontal_oculomotor_slow_saccades_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['oculomotor_motor_apraxia'], 'no' )) {
			$check_oculomotor_motor_apraxia_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['oculomotor_motor_apraxia'], 'yes' )) {
			$check_oculomotor_motor_apraxia_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['oculomotor_vertical_ophtalmoplegia'], 'no' )) {
			$check_oculomotor_vertical_ophtalmoplegia_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['oculomotor_vertical_ophtalmoplegia'], 'yes' )) {
			$check_oculomotor_vertical_ophtalmoplegia_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['oculomotor_horizontal_ophtalmoplegia'], 'no' )) {
			$check_oculomotor_horizontal_ophtalmoplegia_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['oculomotor_horizontal_ophtalmoplegia'], 'yes' )) {
			$check_oculomotor_horizontal_ophtalmoplegia_yes = 'checked';
		}
		
		if (strstr ( $hash_champ_valeur ['intellectual_deterioration'], 'no' )) {
			$check_intellectual_deterioration_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['intellectual_deterioration'], 'yes' )) {
			$check_intellectual_deterioration_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['mental_retardation'], 'no' )) {
			$check_mental_retardation_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['mental_retardation'], 'yes' )) {
			$check_mental_retardation_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['psychiatric_symptoms'], 'no' )) {
			$check_psychiatric_symptoms_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['psychiatric_symptoms'], 'yes' )) {
			$check_psychiatric_symptoms_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['dysphagia'], 'none' )) {
			$check_dysphagia_none = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['dysphagia'], 'mild' )) {
			$check_dysphagia_mild = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['dysphagia'], 'moderate' )) {
			$check_dysphagia_moderate = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['dysphagia'], 'severe' )) {
			$check_dysphagia_severe = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['skin_problems'], 'no' )) {
			$check_skin_problems_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['skin_problems'], 'yes' )) {
			$check_skin_problems_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['hearing_impairment'], 'no' )) {
			$check_hearing_impairment_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['hearing_impairment'], 'yes' )) {
			$check_hearing_impairment_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['epilepsy'], 'no' )) {
			$check_epilepsy_no = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['epilepsy'], 'yes' )) {
			$check_epilepsy_yes = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['diagnostic_cerebellar_ataxia_type'], 'autosomal_dominant' )) {
			$check_diagnostic_cerebellar_ataxia_autosomal_dominant = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['diagnostic_cerebellar_ataxia_type'], 'autosomal_recessive' )) {
			$check_diagnostic_cerebellar_ataxia_autosomal_recessive = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['diagnostic_cerebellar_ataxia_type'], 'isolated_case' )) {
			$check_diagnostic_cerebellar_ataxia_isolated_case = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['diagnostic_cerebellar_ataxia_type'], 'Xlinked' )) {
			$check_diagnostic_cerebellar_ataxia_Xlinked = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['diagnostic_cerebellar_ataxia_form'], 'pure' )) {
			$check_diagnostic_cerebellar_ataxia_pure = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['diagnostic_cerebellar_ataxia_form'], 'complicated' )) {
			$check_diagnostic_cerebellar_ataxia_complicated = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['diagnostic_cerebellar_ataxia_affection'], 'definitely_affected' )) {
			$check_diagnostic_cerebellar_ataxia_definitely_affected = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['diagnostic_cerebellar_ataxia_affection'], 'probably_affected' )) {
			$check_diagnostic_cerebellar_ataxia_probably_affected = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['diagnostic_cerebellar_ataxia_affection'], 'possibly_affected' )) {
			$check_diagnostic_cerebellar_ataxia_possibly_affected = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['diagnostic_spastic_parapesis_type'], 'autosomal_dominant' )) {
			$check_diagnostic_spastic_parapesis_autosomal_dominant = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['diagnostic_spastic_parapesis_type'], 'autosomal_recessive' )) {
			$check_diagnostic_spastic_parapesis_autosomal_recessive = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['diagnostic_spastic_parapesis_type'], 'isolated_case' )) {
			$check_diagnostic_spastic_parapesis_isolated_case = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['diagnostic_spastic_parapesis_type'], 'Xlinked' )) {
			$check_diagnostic_spastic_parapesis_Xlinked = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['diagnostic_spastic_parapesis_form'], 'pure' )) {
			$check_diagnostic_spastic_parapesis_pure = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['diagnostic_spastic_parapesis_form'], 'complicated' )) {
			$check_diagnostic_spastic_parapesis_complicated = 'checked';
		}
		if (strstr ( $hash_champ_valeur ['diagnostic_spastic_parapesis_affection'], 'definitely_affected' )) {
			$check_diagnostic_spastic_parapesis_definitely_affected = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['diagnostic_spastic_parapesis_affection'], 'probably_affected' )) {
			$check_diagnostic_spastic_parapesis_probably_affected = 'checked';
		} elseif (strstr ( $hash_champ_valeur ['diagnostic_spastic_parapesis_affection'], 'possibly_affected' )) {
			$check_diagnostic_spastic_parapesis_possibly_affected = 'checked';
		}
		
		if ($hash_champ_valeur ['cerebral_mri'] === 'not_done') {
			$check_cerebral_mri_not_done = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri'] === 'normal') {
			$check_cerebral_mri_normal = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri'] === 'abnormal') {
			$check_cerebral_mri_abnormal = 'checked';
		}
		if ($hash_champ_valeur ['cerebral_mri_cerebrum_specify'] === 'none') {
			$check_cerebral_mri_cerebrum_specify_none = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri_cerebrum_specify'] === 'mild') {
			$check_cerebral_mri_cerebrum_specify_mild = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri_cerebrum_specify'] === 'moderate') {
			$check_cerebral_mri_cerebrum_specify_moderate = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri_cerebrum_specify'] === 'severe') {
			$check_cerebral_mri_cerebrum_specify_severe = 'checked';
		}
		if ($hash_champ_valeur ['cerebral_mri_cerebellum_specify'] === 'none') {
			$check_cerebral_mri_cerebellum_specify_none = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri_cerebellum_specify'] === 'mild') {
			$check_cerebral_mri_cerebellum_specify_mild = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri_cerebellum_specify'] === 'moderate') {
			$check_cerebral_mri_cerebellum_specify_moderate = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri_cerebellum_specify'] === 'severe') {
			$check_cerebral_mri_cerebellum_specify_severe = 'checked';
		}
		if ($hash_champ_valeur ['cerebral_mri_brainstem_specify'] === 'none') {
			$check_cerebral_mri_brainstem_specify_none = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri_brainstem_specify'] === 'mild') {
			$check_cerebral_mri_brainstem_specify_mild = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri_brainstem_specify'] === 'moderate') {
			$check_cerebral_mri_brainstem_specify_moderate = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri_brainstem_specify'] === 'severe') {
			$check_cerebral_mri_brainstem_specify_severe = 'checked';
		}
		if ($hash_champ_valeur ['cerebral_mri_corpus_callosum_specify'] === 'none') {
			$check_cerebral_mri_corpus_callosum_specify_none = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri_corpus_callosum_specify'] === 'mild') {
			$check_cerebral_mri_corpus_callosum_specify_mild = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri_corpus_callosum_specify'] === 'moderate') {
			$check_cerebral_mri_corpus_callosum_specify_moderate = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri_corpus_callosum_specify'] === 'severe') {
			$check_cerebral_mri_corpus_callosum_specify_severe = 'checked';
		}
		if ($hash_champ_valeur ['cerebral_mri_upper_spinal_cord_specify'] === 'none') {
			$check_cerebral_mri_upper_spinal_cord_specify_none = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri_upper_spinal_cord_specify'] === 'mild') {
			$check_cerebral_mri_upper_spinal_cord_specify_mild = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri_upper_spinal_cord_specify'] === 'moderate') {
			$check_cerebral_mri_upper_spinal_cord_specify_moderate = 'checked';
		} elseif ($hash_champ_valeur ['cerebral_mri_upper_spinal_cord_specify'] === 'severe') {
			$check_cerebral_mri_upper_spinal_cord_specify_severe = 'checked';
		}
		if ($hash_champ_valeur ['white_matter_mri_cerebrum_specify'] === 'none') {
			$check_white_matter_mri_cerebrum_specify_none = 'checked';
		} elseif ($hash_champ_valeur ['white_matter_mri_cerebrum_specify'] === 'mild') {
			$check_white_matter_mri_cerebrum_specify_mild = 'checked';
		} elseif ($hash_champ_valeur ['white_matter_mri_cerebrum_specify'] === 'moderate') {
			$check_white_matter_mri_cerebrum_specify_moderate = 'checked';
		} elseif ($hash_champ_valeur ['white_matter_mri_cerebrum_specify'] === 'severe') {
			$check_white_matter_mri_cerebrum_specify_severe = 'checked';
		}
		if ($hash_champ_valeur ['white_matter_mri_cerebellum_specify'] === 'none') {
			$check_white_matter_mri_cerebellum_specify_none = 'checked';
		} elseif ($hash_champ_valeur ['white_matter_mri_cerebellum_specify'] === 'mild') {
			$check_white_matter_mri_cerebellum_specify_mild = 'checked';
		} elseif ($hash_champ_valeur ['white_matter_mri_cerebellum_specify'] === 'moderate') {
			$check_white_matter_mri_cerebellum_specify_moderate = 'checked';
		} elseif ($hash_champ_valeur ['white_matter_mri_cerebellum_specify'] === 'severe') {
			$check_white_matter_mri_cerebellum_specify_severe = 'checked';
		}
		if ($hash_champ_valeur ['white_matter_mri_brainstem_specify'] === 'none') {
			$check_white_matter_mri_brainstem_specify_none = 'checked';
		} elseif ($hash_champ_valeur ['white_matter_mri_brainstem_specify'] === 'mild') {
			$check_white_matter_mri_brainstem_specify_mild = 'checked';
		} elseif ($hash_champ_valeur ['white_matter_mri_brainstem_specify'] === 'moderate') {
			$check_white_matter_mri_brainstem_specify_moderate = 'checked';
		} elseif ($hash_champ_valeur ['white_matter_mri_brainstem_specify'] === 'severe') {
			$check_white_matter_mri_brainstem_specify_severe = 'checked';
		}
		if ($hash_champ_valeur ['white_matter_mri_corpus_callosum_specify'] === 'none') {
			$check_white_matter_mri_corpus_callosum_specify_none = 'checked';
		} elseif ($hash_champ_valeur ['white_matter_mri_corpus_callosum_specify'] === 'mild') {
			$check_white_matter_mri_corpus_callosum_specify_mild = 'checked';
		} elseif ($hash_champ_valeur ['white_matter_mri_corpus_callosum_specify'] === 'moderate') {
			$check_white_matter_mri_corpus_callosum_specify_moderate = 'checked';
		} elseif ($hash_champ_valeur ['white_matter_mri_corpus_callosum_specify'] === 'severe') {
			$check_white_matter_mri_corpus_callosum_specify_severe = 'checked';
		}
		if ($hash_champ_valeur ['white_matter_mri_upper_spinal_cord_specify'] === 'none') {
			$check_white_matter_mri_upper_spinal_cord_specify_none = 'checked';
		} elseif ($hash_champ_valeur ['white_matter_mri_upper_spinal_cord_specify'] === 'mild') {
			$check_white_matter_mri_upper_spinal_cord_specify_mild = 'checked';
		} elseif ($hash_champ_valeur ['white_matter_mri_upper_spinal_cord_specify'] === 'moderate') {
			$check_white_matter_mri_upper_spinal_cord_specify_moderate = 'checked';
		} elseif ($hash_champ_valeur ['white_matter_mri_upper_spinal_cord_specify'] === 'severe') {
			$check_white_matter_mri_upper_spinal_cord_specify_severe = 'checked';
		}
		
		if ($hash_champ_valeur ['medullar_mri'] === 'not_done') {
			$check_medullar_mri_not_done = 'checked';
		} elseif ($hash_champ_valeur ['medullar_mri'] === 'normal') {
			$check_medullar_mri_normal = 'checked';
		} elseif ($hash_champ_valeur ['medullar_mri'] === 'abnormal') {
			$check_medullar_mri_abnormal = 'checked';
		}
		
		// ~ if($hash_champ_valeur['emg_ncv_ul'] === 'not_done'){ $check_emg_ncv_ul_not_done = 'checked';} elseif($hash_champ_valeur['emg_ncv_ul'] === 'normal'){ $check_emg_ncv_ul_normal = 'checked';} elseif($hash_champ_valeur['emg_ncv_ul'] === 'abnormal'){ $check_emg_ncv_ul_abnormal = 'checked';}
		// ~ if($hash_champ_valeur['emg_ncv_ll'] === 'not_done'){ $check_emg_ncv_ll_not_done = 'checked';} elseif($hash_champ_valeur['emg_ncv_ll'] === 'normal'){ $check_emg_ncv_ll_normal = 'checked';} elseif($hash_champ_valeur['emg_ncv_ll'] === 'abnormal'){ $check_emg_ncv_ll_abnormal = 'checked';}
		if ($hash_champ_valeur ['polyneuropathy'] === 'not_done') {
			$check_polyneuropathy_not_done = 'checked';
		} elseif ($hash_champ_valeur ['polyneuropathy'] === 'normal') {
			$check_polyneuropathy_normal = 'checked';
		} elseif ($hash_champ_valeur ['polyneuropathy'] === 'abnormal') {
			$check_polyneuropathy_abnormal = 'checked';
		}
		if ($hash_champ_valeur ['vep'] === 'not_done') {
			$check_vep_not_done = 'checked';
		} elseif ($hash_champ_valeur ['vep'] === 'normal') {
			$check_vep_normal = 'checked';
		} elseif ($hash_champ_valeur ['vep'] === 'abnormal') {
			$check_vep_abnormal = 'checked';
		}
		if ($hash_champ_valeur ['aep'] === 'not_done') {
			$check_aep_not_done = 'checked';
		} elseif ($hash_champ_valeur ['aep'] === 'normal') {
			$check_aep_normal = 'checked';
		} elseif ($hash_champ_valeur ['aep'] === 'abnormal') {
			$check_aep_abnormal = 'checked';
		}
		if ($hash_champ_valeur ['mep'] === 'not_done') {
			$check_mep_not_done = 'checked';
		} elseif ($hash_champ_valeur ['mep'] === 'normal') {
			$check_mep_normal = 'checked';
		} elseif ($hash_champ_valeur ['mep'] === 'abnormal') {
			$check_mep_abnormal = 'checked';
		}
		if ($hash_champ_valeur ['sep'] === 'not_done') {
			$check_sep_not_done = 'checked';
		} elseif ($hash_champ_valeur ['sep'] === 'normal') {
			$check_sep_normal = 'checked';
		} elseif ($hash_champ_valeur ['sep'] === 'abnormal') {
			$check_sep_abnormal = 'checked';
		}
		
		if ($hash_champ_valeur ['albumin'] === 'not_done') {
			$check_albumin_not_done = 'checked';
		} elseif ($hash_champ_valeur ['albumin'] === 'normal') {
			$check_albumin_normal = 'checked';
		} elseif ($hash_champ_valeur ['albumin'] === 'abnormal') {
			$check_albumin_abnormal = 'checked';
		}
		if ($hash_champ_valeur ['cholestanol'] === 'not_done') {
			$check_cholestanol_not_done = 'checked';
		} elseif ($hash_champ_valeur ['cholestanol'] === 'normal') {
			$check_cholestanol_normal = 'checked';
		} elseif ($hash_champ_valeur ['cholestanol'] === 'abnormal') {
			$check_cholestanol_abnormal = 'checked';
		}
		if ($hash_champ_valeur ['_25OHcholesterol'] === 'not_done') {
			$check_25OHcholesterol_not_done = 'checked';
		} elseif ($hash_champ_valeur ['_25OHcholesterol'] === 'normal') {
			$check_25OHcholesterol_normal = 'checked';
		} elseif ($hash_champ_valeur ['_25OHcholesterol'] === 'abnormal') {
			$check_25OHcholesterol_abnormal = 'checked';
		}
		if ($hash_champ_valeur ['_27OHcholesterol'] === 'not_done') {
			$check_27OHcholesterol_not_done = 'checked';
		} elseif ($hash_champ_valeur ['_27OHcholesterol'] === 'normal') {
			$check_27OHcholesterol_normal = 'checked';
		} elseif ($hash_champ_valeur ['_27OHcholesterol'] === 'abnormal') {
			$check_27OHcholesterol_abnormal = 'checked';
		}
		if ($hash_champ_valeur ['other_biology'] === 'not_done') {
			$check_other_biology_not_done = 'checked';
		} elseif ($hash_champ_valeur ['other_biology'] === 'normal') {
			$check_other_biology_normal = 'checked';
		} elseif ($hash_champ_valeur ['other_biology'] === 'abnormal') {
			$check_other_biology_abnormal = 'checked';
		}
		if ($hash_champ_valeur ['vlcfa'] === 'not_done') {
			$check_vlcfa_not_done = 'checked';
		} elseif ($hash_champ_valeur ['vlcfa'] === 'normal') {
			$check_vlcfa_normal = 'checked';
		} elseif ($hash_champ_valeur ['vlcfa'] === 'abnormal') {
			$check_vlcfa_abnormal = 'checked';
		}
		if ($hash_champ_valeur ['alphafoetoprotein'] === 'not_done') {
			$check_alphafoetoprotein_not_done = 'checked';
		} elseif ($hash_champ_valeur ['alphafoetoprotein'] === 'normal') {
			$check_alphafoetoprotein_normal = 'checked';
		} elseif ($hash_champ_valeur ['alphafoetoprotein'] === 'abnormal') {
			$check_alphafoetoprotein_abnormal = 'checked';
		}
		if ($hash_champ_valeur ['cholesterol'] === 'not_done') {
			$check_cholesterol_not_done = 'checked';
		} elseif ($hash_champ_valeur ['cholesterol'] === 'normal') {
			$check_cholesterol_normal = 'checked';
		} elseif ($hash_champ_valeur ['cholesterol'] === 'abnormal') {
			$check_cholesterol_abnormal = 'checked';
		}
		// ~ if($hash_champ_valeur['serum_protein_electrophoresis'] === 'not_done'){ $check_serum_protein_electrophoresis_not_done = 'checked';} elseif($hash_champ_valeur['serum_protein_electrophoresis'] === 'normal'){ $check_serum_protein_electrophoresis_normal = 'checked';} elseif($hash_champ_valeur['serum_protein_electrophoresis'] === 'abnormal'){ $check_serum_protein_electrophoresis_abnormal = 'checked';}
		if ($hash_champ_valeur ['vitamin_E'] === 'not_done') {
			$check_vitamin_E_not_done = 'checked';
		} elseif ($hash_champ_valeur ['vitamin_E'] === 'normal') {
			$check_vitamin_E_normal = 'checked';
		} elseif ($hash_champ_valeur ['vitamin_E'] === 'abnormal') {
			$check_vitamin_E_abnormal = 'checked';
		}
		if ($hash_champ_valeur ['apolipoprotein_AB'] === 'not_done') {
			$check_apolipoprotein_AB_not_done = 'checked';
		} elseif ($hash_champ_valeur ['apolipoprotein_AB'] === 'normal') {
			$check_apolipoprotein_AB_normal = 'checked';
		} elseif ($hash_champ_valeur ['apolipoprotein_AB'] === 'abnormal') {
			$check_apolipoprotein_AB_abnormal = 'checked';
		}
		
		// ~ if($hash_champ_valeur['muscle_biopsy'] === 'not_done'){ $check_muscle_biopsy_not_done = 'checked';} elseif($hash_champ_valeur['muscle_biopsy'] === 'normal'){ $check_muscle_biopsy_normal = 'checked';} elseif($hash_champ_valeur['muscle_biopsy'] === 'abnormal'){ $check_muscle_biopsy_abnormal = 'checked';}
		// ~ if($hash_champ_valeur['skin_biopsy'] === 'not_done'){ $check_skin_biopsy_not_done = 'checked';} elseif($hash_champ_valeur['skin_biopsy'] === 'normal'){ $check_skin_biopsy_normal = 'checked';} elseif($hash_champ_valeur['skin_biopsy'] === 'abnormal'){ $check_skin_biopsy_abnormal = 'checked';}
		// ~ if($hash_champ_valeur['erg'] === 'not_done'){ $check_erg_not_done = 'checked';} elseif($hash_champ_valeur['erg'] === 'normal'){ $check_erg_normal = 'checked';} elseif($hash_champ_valeur['erg'] === 'abnormal'){ $check_erg_abnormal = 'checked';}
		// ~ if($hash_champ_valeur['fundus_examination'] === 'not_done'){ $check_fundus_examination_not_done = 'checked';} elseif($hash_champ_valeur['fundus_examination'] === 'normal'){ $check_fundus_examination_normal = 'checked';} elseif($hash_champ_valeur['fundus_examination'] === 'abnormal'){ $check_fundus_examination_abnormal = 'checked';}
		// ~ if($hash_champ_valeur['iq'] === 'not_done'){ $check_iq_not_done = 'checked';} elseif($hash_champ_valeur['iq'] === 'normal'){ $check_iq_normal = 'checked';} elseif($hash_champ_valeur['iq'] === 'abnormal'){ $check_iq_abnormal = 'checked';}
		// ~ if($hash_champ_valeur['urodynamics'] === 'not_done'){ $check_urodynamics_not_done = 'checked';} elseif($hash_champ_valeur['urodynamics'] === 'normal'){ $check_urodynamics_normal = 'checked';} elseif($hash_champ_valeur['urodynamics'] === 'abnormal'){ $check_urodynamics_abnormal = 'checked';}
		// ~ if($hash_champ_valeur['urine_density'] === 'not_done'){ $check_urine_density_not_done = 'checked';} elseif($hash_champ_valeur['urine_density'] === 'normal'){ $check_urine_density_normal = 'checked';} elseif($hash_champ_valeur['urine_density'] === 'abnormal'){ $check_urine_density_abnormal = 'checked';}
		if ($hash_champ_valeur ['dna'] === 'yes') {
			$check_dna_yes = 'checked';
		} elseif ($hash_champ_valeur ['dna'] === 'no') {
			$check_dna_no = 'checked';
		}
		if ($hash_champ_valeur ['nbia'] === 'yes') {
			$check_nbia_yes = 'checked';
		} elseif ($hash_champ_valeur ['nbia'] === 'no') {
			$check_nbia_no = 'checked';
		}
		if ($hash_champ_valeur ['immortalized_cell_lines'] === 'yes') {
			$check_immortalized_cell_lines_yes = 'checked';
		} elseif ($hash_champ_valeur ['immortalized_cell_lines'] === 'no') {
			$check_immortalized_cell_lines_no = 'checked';
		}
		if ($hash_champ_valeur ['muscle_tissue'] === 'yes') {
			$check_muscle_tissue_yes = 'checked';
		} elseif ($hash_champ_valeur ['muscle_tissue'] === 'no') {
			$check_muscle_tissue_no = 'checked';
		}
		if ($hash_champ_valeur ['stored_skin_biopsy'] === 'yes') {
			$check_stored_skin_biopsy_yes = 'checked';
		} elseif ($hash_champ_valeur ['stored_skin_biopsy'] === 'no') {
			$check_stored_skin_biopsy_no = 'checked';
		}
		// ~ if($hash_champ_valeur['nerve_biopsy'] === 'yes'){ $check_nerve_biopsy_yes = 'checked';}elseif($hash_champ_valeur['nerve_biopsy'] === 'no'){ $check_nerve_biopsy_no = 'checked';}
		
		if ($_GET ['form'] == 'new') {
			if (isset ( $_SESSION ['code1'] )) {
				$hash_champ_valeur ['code1'] = $_SESSION ['code1'];
			}
			if (isset ( $_SESSION ['code2'] )) {
				$hash_champ_valeur ['code2'] = $_SESSION ['code2'];
			}
			if (isset ( $_SESSION ['code3'] )) {
				$hash_champ_valeur ['code3'] = $_SESSION ['code3'];
			}
			if (isset ( $_SESSION ['code4'] )) {
				$hash_champ_valeur ['code4'] = $_SESSION ['code4'];
			}
			if (isset ( $_SESSION ['code5'] )) {
				$hash_champ_valeur ['code5'] = $_SESSION ['code5'];
			}
			if (isset ( $_SESSION ['status'] )) {
				$status = $_SESSION ['status'];
			}
			if (isset ( $_SESSION ['validation'] )) {
				$validation = $_SESSION ['validation'];
			}
		}
		
		$disabled_tous = '';
		if ($_SESSION ['acces_clinique'] >= 2) {
			
			if ($_SESSION ['modification_groupe'] == '0') {
				$disabled_tous = 'disabled';
			} else {
				if ($_SESSION ['id'] != $hash_champ_valeur ['user']) {
					$querygroupe_user = "SELECT `ID_people_groupe`
					FROM `users`
					WHERE `last_name` LIKE '" . $hash_champ_valeur ['user'] . "';";
					$resultgroupe_user = mysql_query ( $querygroupe_user ) or die ( "Impossible de r&#233;cup&#233;rer la liste des groupes" . mysql_error () );
					while ( $line = mysql_fetch_array ( $resultgroupe_user ) ) {
						$groupe_user = $line ['ID_people_groupe'];
					}
					// ~ echo $querygroupe_user."<br />";
					if ($_SESSION ['ID_people_groupe'] == $groupe_user && $_SESSION ['modification_groupe'] < 2) { // cas ou modif user dans le meme groupe mais n'a pas les droits
						$disabled_tous = 'disabled';
					} elseif ($_SESSION ['ID_people_groupe'] != $groupe_user and $_SESSION ['modification_groupe'] < 3) { // cas ou pas dans le meme groupe, masi tous les droits
						$disabled_tous = 'disabled';
					} else {
						echo "<form id='frm' action=\"page_principale.php?form=$form&amp;submit=yes\" method='post' enctype='multipart/form-data'>";
					}
				} else { // cas où modifications sur tout
					echo "<form id='frm' action=\"page_principale.php?form=$form&amp;submit=yes\" method='post' enctype='multipart/form-data'>";
				}
			}
		} else {
			$disabled_tous = 'disabled';
			echo "cas 4<br />";
		}
		// ~ echo "<br />"."ID_people_groupe : ".$_SESSION['ID_people_groupe']." modification_groupe : ".$_SESSION['modification_groupe']." groupe_user : ". $groupe_user."<br />";
		?>

<table class='principale'>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td colspan='4'><b>DIAGNOSTIC FORM FOR SPINOCEREBELLAR DEGENERATION <br />(ATAXIA
				AND/OR SPASTIC PARAPARESIS)
		</b></td>
	</tr>
</table>

<table class='principale'>
	<tr>
		<td><input <?php echo $disabled_tous.' ';?> type="button"
			OnClick="window.location.href='../start.php'"
			value='Exit without saving' /></td>
		<td><input <?php echo $disabled_tous.' ';?> type='submit'
			name='submitprinc' value='Save' /></td>

		<td><input <?php echo $disabled_tous;?> type="button"
			Onclick="javascript:window.print()" value="Print" /></td>
	</tr>
</table>

<table class='principale'>
	<tr>
		<td><i>User : </i><input <?php echo $disabled_tous;?> type="text"
			name="user" readonly="readonly" style="width: 200px; border: none;"
			value="<?php if(isset($hash_champ_valeur['user']) and $hash_champ_valeur['user'] != ''){ echo strtoupper($hash_champ_valeur['user']); }else{ echo 'unknown'; } ?>" /></td>
		<td><i>Last modifier : </i><input <?php echo $disabled_tous;?>
			type="text" name="last_modifier" readonly="readonly"
			style="width: 200px; border: none;"
			value="<?php if(isset($hash_champ_valeur['last_modifier']) and $hash_champ_valeur['last_modifier'] != ''){ echo strtoupper($hash_champ_valeur['last_modifier']);}else{ echo strtoupper($hash_champ_valeur['user']); } ?>" /></td>
	</tr>
</table>

<table class='principale'>
		<?php
		if ($_SESSION ['acces_clinique'] >= 3) {
			echo "<tr><td>User : </td><td><input " . $disabled_tous . " type='text' style='width:100px' name='user' value='";
			if (isset ( $hash_champ_valeur ['user'] ) and $hash_champ_valeur ['user'] != '') {
				echo $hash_champ_valeur ['user'];
			} else {
				echo strtoupper ( $_SESSION ['id'] );
			}
			echo "' /></td></tr>";
		}
		?>
		
		<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>Form number :</td>
		<td><input <?php echo $disabled_tous;?> type="text" name="form"
			size="5" readonly="readonly"
			value="<?php echo $hash_champ_valeur['form']; ?>" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>Neurologist :</td>
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 200px;" name="neurologist"
			value="<?php echo $hash_champ_valeur['neurologist']; ?>" /></td>
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>Date :</td>
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="date"
			value="<?php echo $hash_champ_valeur['date']; ?>"
			onBlur="onBlurDate(this);" />&#40;yyyy&#45;mm&#45;dd&#41;</td>
		
		<?php
		$liste_centers = Array ();
		$requete_liste_centers = "SELECT DISTINCT `center` FROM `centres` ORDER BY `center`;";
		$resultat_liste_centers = mysql_query ( $requete_liste_centers ) or die ( "Error liste centers : " . mysql_error () );
		// ~ $resultat_liste_centers = mysqli_query($link,$requete_liste_centers) or die("Error liste centers : " . mysql_error());
		while ( $ligne = mysql_fetch_array ( $resultat_liste_centers ) ) {
			// ~ while($ligne = mysqli_fetch_array($resultat_liste_centers)) {
			array_push ( $liste_centers, $ligne [0] );
		}
		
		?>
		<td>Center :</td>
		<td><select <?php echo $disabled_tous;?> name="center" id="center">
				<option></option>
			<?php
		
		foreach ( $liste_centers as $center ) {
			echo "<option value='$center'";
			if (isset ( $hash_champ_valeur ['center'] ) and $hash_champ_valeur ['center'] == $center) {
				echo "selected='selected'";
				$requete_vide = 'non';
			}
			echo " > $center </option>";
		}
		?>
		</select></td>
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>Code ID patient :</td>
		<td><input <?php echo $disabled_tous;?> type="text" maxlength="3"
			size="3" name="code1" id="code1"
			value="<?php echo $hash_champ_valeur['code1']; ?>" />- <input
			<?php echo $disabled_tous;?> type="text" maxlength="3" size="3"
			name="code2" id="code2"
			value="<?php echo $hash_champ_valeur['code2']; ?>" />- <input
			<?php echo $disabled_tous;?> type="text" maxlength="3" size="3"
			name="code3" id="code3"
			value="<?php echo $hash_champ_valeur['code3']; ?>" />- <input
			<?php echo $disabled_tous;?> type="text" maxlength="4" size="4"
			name="code4" id="code4"
			value="<?php echo $hash_champ_valeur['code4']; ?>" />- <input
			<?php echo $disabled_tous;?> type="text" maxlength="5" size="5"
			name="code5" id="code5"
			value="<?php echo $hash_champ_valeur['code5']; ?>" />
		<?php
		if (file_exists ( '../uploads/pedigree/' . $hash_champ_valeur ['code1'] . '-' . $hash_champ_valeur ['code2'] . '-' . $hash_champ_valeur ['code3'] . '-' . $hash_champ_valeur ['code4'] . '.ppt' )) {
			echo "<a target=_blank href='../uploads/pedigree/" . $hash_champ_valeur ['code1'] . '-' . $hash_champ_valeur ['code2'] . '-' . $hash_champ_valeur ['code3'] . '-' . $hash_champ_valeur ['code4'] . ".ppt'><img src='../images/logo_arbre.png' height='15' /> </a>";
		}
		?>
		</td>
		<td>Birthdate :</td>
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="birthdate"
			value="<?php echo $hash_champ_valeur['birthdate']; ?>"
			onBlur="onBlurDate(this);" />&#40;yyyy&#45;mm&#45;dd&#41;</td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>NIP :</td>
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="nip"
			value="<?php echo $hash_champ_valeur['nip']; ?>" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>Proband :</td>
		<td><label><input <?php echo $disabled_tous;?> type="radio"
				id='proband0' onclick="uncheck('proband', 0)" name="proband"
				<?php if(isset($check_proband_yes)){echo $check_proband_yes;} ?>
				value="yes" />yes</label> <label><input <?php echo $disabled_tous;?>
				type="radio" id='proband1' onclick="uncheck('proband', 1)"
				name="proband"
				<?php if(isset($check_proband_no)){echo $check_proband_no;} ?>
				value="no" />no</label></td>
		<input <?php echo $disabled_tous;?> type="hidden" id="proband_temp"
			value='' />
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>Sex :</td>
		<td><label><input <?php echo $disabled_tous;?> type="radio" id='sex0'
				onclick="uncheck('sex', 0)" name="sex"
				<?php if(isset($check_sex_female)){echo $check_sex_female;} ?>
				value="female" />female</label> <label><input
				<?php echo $disabled_tous;?> type="radio" id='sex1'
				onclick="uncheck('sex', 1)" name="sex"
				<?php if(isset($check_sex_male)){echo $check_sex_male;}?>
				value="male" />male</label></td>
		<input <?php echo $disabled_tous;?> type="hidden" id="sex_temp"
			value='' />
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>Initial exam :</td>
		<td><label><input <?php echo $disabled_tous;?> type="radio"
				id='initialexam0' onclick="uncheck('initialexam', 0)"
				name="initialexam"
				<?php if(isset($check_initialexam_yes)){echo $check_initialexam_yes;} ?>
				value="yes" />yes</label> <label><input <?php echo $disabled_tous;?>
				type="radio" id='sinitialexam1' onclick="uncheck('initialexam', 1)"
				name="initialexam"
				<?php if(isset($check_initialexam_no)){echo $check_initialexam_no;} ?>
				value="no" />no</label></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="initialexam_temp" value='' />
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>Follow up n&#176; :</td>
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="followup"
			value="<?php if(isset($followup)){echo $followup;} ?>" /></td>
	</tr>


	<!--<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'"><td><input type="button" name="see_genetics" Value="See genetics" onClick="recupere_genetique('code1','code2','code3','code4','code5');" /></td></tr> ------>

</table>

<!------------------------------------->

<table class='principale'>
	<tr>
		<td colspan="4"><p style="">
				<b>A. FAMILIAL HISTORY</b>
			</p></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
		<td><b>Yes</b></td>
		<td><b>No</b></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Spastic parapesis and/or ataxia in the family ?</td>
		<td class='lisible'><label><input <?php echo $disabled_tous;?>
				type="radio" id='ps_or_ataxia_in_family0'
				onclick="uncheck('ps_or_ataxia_in_family', 0)"
				name="ps_or_ataxia_in_family"
				<?php if(isset($check_ps_or_ataxia_in_family_yes)){echo $check_ps_or_ataxia_in_family_yes;} ?>
				value="yes" /></label></td>
		<td class='lisible'><label><input <?php echo $disabled_tous;?>
				type="radio" id='ps_or_ataxia_in_family1'
				onclick="uncheck('ps_or_ataxia_in_family', 1)"
				name="ps_or_ataxia_in_family"
				<?php if(isset($check_ps_or_ataxia_in_family_no)){echo $check_ps_or_ataxia_in_family_no;} ?>
				value="no" /></label></td>
	</tr>
	<input <?php echo $disabled_tous;?> type="hidden"
		id="ps_or_ataxia_in_family_temp" value='' />

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Other familial disease</td>
		<td class='lisible'><label><input <?php echo $disabled_tous;?>
				type="radio" id='other_familial_disease0'
				onclick="uncheck('other_familial_disease', 0)"
				<?php if(isset($check_other_familial_disease_yes)){echo $check_other_familial_disease_yes;} ?>
				name="other_familial_disease" value="yes" /></label></td>
		<td class='lisible'><label><input <?php echo $disabled_tous;?>
				type="radio" id='other_familial_disease1'
				onclick="uncheck('other_familial_disease', 1)"
				<?php if(isset($check_other_familial_disease_no)){echo $check_other_familial_disease_no;} ?>
				name="other_familial_disease" value="no" /></label></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="other_familial_disease_temp" value='' />
		<td>Specify : <input <?php echo $disabled_tous;?> type="text"
			style="width: 200px;" name="specify_other_familial_disease"
			value="<?php echo $hash_champ_valeur['specify_other_familial_disease']; ?>" /></td>
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Consanguinity</td>
		<td class='lisible'><label><input <?php echo $disabled_tous;?>
				type="radio" id='consanguinity0'
				onclick="uncheck('consanguinity', 0)" name="consanguinity"
				<?php if(isset($check_consanguinity_yes)){echo $check_consanguinity_yes;} ?>
				value="yes" /></label></td>
		<td class='lisible'><label><input <?php echo $disabled_tous;?>
				type="radio" id='consanguinity1'
				onclick="uncheck('consanguinity', 1)" name="consanguinity"
				<?php if(isset($check_consanguinity_no)){echo $check_consanguinity_no;} ?>
				value="no" /></label></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="consanguinity_temp" value='' />
		<td>Specify : <input <?php echo $disabled_tous;?> type="text"
			style="width: 200px;" name="specify_consanguinity"
			value="<?php echo $hash_champ_valeur['specify_consanguinity']; ?>" /></td>
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Parental inheritance of the disease</td>
		<td class='lisible'><label><input <?php echo $disabled_tous;?>
				type="radio" id='parental_inheritance0'
				onclick="uncheck('parental_inheritance', 0)"
				name="parental_inheritance"
				<?php if(isset($check_parental_inheritance_paternal)){echo $check_parental_inheritance_paternal;} ?>
				value="paternal" />Paternal</label></td>
		<td class='lisible'><label><input <?php echo $disabled_tous;?>
				type="radio" id='parental_inheritance1'
				onclick="uncheck('parental_inheritance', 1)"
				name="parental_inheritance"
				<?php if(isset($check_parental_inheritance_maternal)){echo $check_parental_inheritance_maternal;} ?>
				value="maternal" />Maternal</label></td>
		<td>Comments : <input <?php echo $disabled_tous;?> type="text"
			style="width: 200px;" name="parental_inheritance_comments"
			value="<?php echo $hash_champ_valeur['parental_inheritance_comments']; ?>" /></td>
	</tr>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td colspan="3">Geographical origin of the transmitting parent: <input
			<?php echo $disabled_tous;?> type="text" style="width: 200px;"
			name="geographical_origin"
			value="<?php echo $hash_champ_valeur['geographical_origin']; ?>" />
			Age of death <input <?php echo $disabled_tous;?> type="text"
			maxlength="5" size="3" name="age_of_death"
			value="<?php echo $hash_champ_valeur['age_of_death']; ?>"
			onBlur="onBlurNombre(this);" />
		</td>
	</tr>
</table>

<!------------------------------------->

<table class='principale'>
	<tr>
		<td colspan="4"><p style="">
				<b>B. AGE</b>
			</p></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>Age at onset :</td>
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="onset_age"
			value="<?php echo $hash_champ_valeur['onset_age']; ?>"
			onBlur="onBlurNombre(this);" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>Age at examination :</td>
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="examination_age"
			value="<?php echo $hash_champ_valeur['examination_age']; ?>"
			onBlur="onBlurNombre(this);" /></td>
	</tr>
</table>

<!------------------------------------->

<table class='principale'>
	<tr>
		<td colspan="4"><p style="">
				<b>C. DEVELOPMENT AND SIGNS AT ONSET</b>
			</p></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
		<td><b> Normal </b></td>
		<td><b> Delayed </b></td>
		<td><b> Specify </b></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Motor development</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='motor_development0' onclick="uncheck('motor_development', 0)"
			name="motor_development"
			<?php if(isset($check_motor_development_normal)){echo $check_motor_development_normal;} ?>
			value="normal" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='motor_development1' onclick="uncheck('motor_development', 1)"
			name="motor_development"
			<?php if(isset($check_motor_development_delayed)){echo $check_motor_development_delayed;} ?>
			value="delayed" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="motor_development_temp" value='' />
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 200px;" name="specify_motor_development"
			value="<?php echo $hash_champ_valeur['specify_motor_development']; ?>" /></td>
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Intellect. development</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='intellect_development0'
			onclick="uncheck('intellect_development', 0)"
			name="intellect_development"
			<?php if(isset($check_intellect_development_normal)){echo $check_intellect_development_normal;} ?>
			value="normal" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='intellect_development1'
			onclick="uncheck('intellect_development', 1)"
			name="intellect_development"
			<?php if(isset($check_intellect_development_delayed)){echo $check_intellect_development_delayed;} ?>
			value="delayed" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="intellect_development_temp" value='' />
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 200px;" name="specify_intellect_development"
			value="<?php echo $hash_champ_valeur['specify_intellect_development']; ?>" /></td>
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>Signs at onset </b></td>
		<td><b> yes </b></td>
		<td><b> no </b></td>
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Unsteadiness</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='unsteadiness0' onclick="uncheck('unsteadiness', 0)"
			name="unsteadiness"
			<?php if(isset($check_unsteadiness_yes)){echo $check_unsteadiness_yes;} ?>
			value="yes" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='unsteadiness1' onclick="uncheck('unsteadiness', 1)"
			name="unsteadiness"
			<?php if(isset($check_unsteadiness_no)){echo $check_unsteadiness_no;} ?>
			value="no" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="unsteadiness_temp" value='' />
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Dysarthria</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='dysarthria0' onclick="uncheck('dysarthria', 0)" name="dysarthria"
			<?php if(isset($check_dysarthria_yes)){echo $check_dysarthria_yes;} ?>
			value="yes" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='dysarthria1' onclick="uncheck('dysarthria', 1)" name="dysarthria"
			<?php if(isset($check_dysarthria_no)){echo $check_dysarthria_no;} ?>
			value="no" /></td>
		<input <?php echo $disabled_tous;?> type="hidden" id="dysarthria_temp"
			value='' />
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Stiff legs</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='stiff_legs0' onclick="uncheck('stiff_legs', 0)" name="stiff_legs"
			<?php if(isset($check_stiff_legs_yes)){echo $check_stiff_legs_yes;} ?>
			value="yes" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='stiff_legs1' onclick="uncheck('stiff_legs', 1)" name="stiff_legs"
			<?php if(isset($check_stiff_legs_no)){echo $check_stiff_legs_no;}?>
			value="no" /></td>
		<input <?php echo $disabled_tous;?> type="hidden" id="stiff_legs_temp"
			value='' />
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Cramps</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cramps0' onclick="uncheck('cramps', 0)" name="cramps"
			<?php if(isset($check_cramps_yes)){echo $check_cramps_yes;} ?>
			value="yes" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cramps1' onclick="uncheck('cramps', 1)" name="cramps"
			<?php if(isset($check_cramps_no)){echo $check_cramps_no;} ?>
			value="no" /></td>
		<input <?php echo $disabled_tous;?> type="hidden" id="cramps_temp"
			value='' />
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Pain</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='pain0' onclick="uncheck('pain', 0)" name="pain"
			<?php if(isset($check_pain_yes)){echo $check_pain_yes;} ?>
			value="yes" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='pain1' onclick="uncheck('pain', 1)" name="pain"
			<?php if(isset($check_pain_no)){echo $check_pain_no;} ?> value="no" /></td>
		<input <?php echo $disabled_tous;?> type="hidden" id="pain_temp"
			value='' />
		</td>
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Diplopia</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='diplopia_at_onset0' onclick="uncheck('diplopia_at_onset', 0)"
			name="diplopia_at_onset"
			<?php if(isset($check_diplopia_at_onset_yes)){echo $check_diplopia_at_onset_yes;} ?>
			value="yes" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='diplopia_at_onset1' onclick="uncheck('diplopia_at_onset', 1)"
			name="diplopia_at_onset"
			<?php if(isset($check_diplopia_at_onset_no)){echo $check_diplopia_at_onset_no;} ?>
			value="no" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="diplopia_at_onset_temp" value='' />
		</td>
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>Other :</td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='other_signs_onset0' onclick="uncheck('other_signs_onset', 0)"
			name="other_signs_onset"
			<?php if(isset($check_other_signs_onset_yes)){echo $check_other_signs_onset_yes;} ?>
			value="yes" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='other_signs_onset1' onclick="uncheck('other_signs_onset', 1)"
			name="other_signs_onset"
			<?php if(isset($check_other_signs_onset_no)){echo $check_other_signs_onset_no;} ?>
			value="no"></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="other_signs_onset_temp" value='' />
		<td><textarea <?php echo $disabled_tous;?> type="text"
				style="width: 200px;" id="specify_other_signs_onset"
				name="specify_other_signs_onset"><?php if(isset($hash_champ_valeur['specify_other_signs_onset'])){ echo $hash_champ_valeur['specify_other_signs_onset'];} ?></textarea></td>
	</tr>
</table>

<!------------------------------------->


<table class='principale'>
	<tr>
		<td colspan="4"><p style="">
				<b>E. DISABILITY STAGE</b>
			</p></td>
	</tr>
	<tr>
		<td></td>
		<td><b>At age</b></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><label><input <?php echo $disabled_tous;?> type="radio"
				id='disability_stage0' onclick="uncheck('disability_stage', 0)"
				name="disability_stage"
				<?php if(isset($check_disability_stage_0)){echo $check_disability_stage_0;} ?>
				value="0" /> 0: no functional handicap </label></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><label><input <?php echo $disabled_tous;?> type="radio"
				id='disability_stage1' onclick="uncheck('disability_stage', 1)"
				name="disability_stage"
				<?php if(isset($check_disability_stage_1)){echo $check_disability_stage_1;} ?>
				value="1" /> 1: no functional handicap but signs at examination </label></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><label><input <?php echo $disabled_tous;?> type="radio"
				id='disability_stage2' onclick="uncheck('disability_stage', 2)"
				name="disability_stage"
				<?php if(isset($check_disability_stage_2)){echo $check_disability_stage_2;} ?>
				value="2" /> 2: mild, able to run, walking unlimited </label></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><label><input <?php echo $disabled_tous;?> type="radio"
				id='disability_stage3' onclick="uncheck('disability_stage', 3)"
				name="disability_stage"
				<?php if(isset($check_disability_stage_3)){echo $check_disability_stage_3;} ?>
				value="3" /> 3: moderate, unable to run, limited walking without aid
		</label></td>
		<td><input <?php echo $disabled_tous;?> type="text" maxlength="3"
			size="3" name="age_disability_stage3"
			value="<?php echo $hash_champ_valeur['age_disability_stage3']; ?>"
			onBlur="onBlurNombre(this);" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><label><input <?php echo $disabled_tous;?> type="radio"
				id='disability_stage4' onclick="uncheck('disability_stage', 4)"
				name="disability_stage"
				<?php if(isset($check_disability_stage_4)){echo $check_disability_stage_4;} ?>
				value="4" /> 4: severe, walking with one stick </label></td>
		<td><input <?php echo $disabled_tous;?> type="text" maxlength="3"
			size="3" name="age_disability_stage4"
			value="<?php echo $hash_champ_valeur['age_disability_stage4']; ?>"
			onBlur="onBlurNombre(this);" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><label><input <?php echo $disabled_tous;?> type="radio"
				id='disability_stage5' onclick="uncheck('disability_stage', 5)"
				name="disability_stage"
				<?php if(isset($check_disability_stage_5)){echo $check_disability_stage_5;} ?>
				value="5" /> 5: walking with two sticks </label></td>
		<td><input <?php echo $disabled_tous;?> type="text" maxlength="3"
			size="3" name="age_disability_stage5"
			value="<?php echo $hash_champ_valeur['age_disability_stage5']; ?>"
			onBlur="onBlurNombre(this);" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><label><input <?php echo $disabled_tous;?> type="radio"
				id='disability_stage6' onclick="uncheck('disability_stage', 6)"
				name="disability_stage"
				<?php if(isset($check_disability_stage_6)){echo $check_disability_stage_6;} ?>
				value="6" /> 6: unable to walk, requiring wheelchair </label></td>
		<td><input <?php echo $disabled_tous;?> type="text" maxlength="3"
			size="3" name="age_disability_stage6"
			value="<?php echo $hash_champ_valeur['age_disability_stage6']; ?>"
			onBlur="onBlurDisablityStage(this,<?php echo $hash_champ_valeur['onset_age']; ?>);" /></td>
		<td>disability index = <?php
		
		if (isset ( $hash_champ_valeur ['age_disability_stage6'] ) and isset ( $onset_age )) {
			echo (6 / ($hash_champ_valeur ['age_disability_stage6'] - $onset_age));
		} else {
			echo "<i>Disability stage 6 not filled</i>";
		}
		
		?></td>
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><label><input <?php echo $disabled_tous;?> type="radio"
				id='disability_stage7' onclick="uncheck('disability_stage', 7)"
				name="disability_stage"
				<?php if(isset($check_disability_stage_7)){echo $check_disability_stage_7;} ?>
				value="7" /> 7: confined to bed </label></td>
		<td><input <?php echo $disabled_tous;?> type="text" maxlength="3"
			size="3" name="age_disability_stage7"
			value="<?php echo $hash_champ_valeur['age_disability_stage7']; ?>"
			onBlur="onBlurNombre(this);" /></td>
	</tr>
	<input <?php echo $disabled_tous;?> type="hidden"
		id="disability_stage_temp" value='' />
</table>

<!------------------------------------->

<table class='principale'>
	<tr>
		<td colspan="4"><p style="">
				<b>F. OTHER CLINICAL SIGNS</b>
			</p></td>
	</tr>
	<tr>
		<td>

			<table class="secondaire">
				<tr>
					<td colspan="4"><p style="">
							<b>1. Reflexes</b>
						</p></td>
				</tr>
				<tr>
					<td></td>
					<td><b> Normal </b></td>
					<td><b> Increased </b></td>
					<td><b> Diffused </b></td>
					<td><b> Decreased </b></td>
					<td><b> Absent </b></td>
					<td><b> Clonus </b></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Jaw jerk</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='jaw_jerk0' onclick="uncheck('jaw_jerk', 0)"
						name="jaw_jerk"
						<?php if(isset($check_jaw_jerk_normal)){echo $check_jaw_jerk_normal;} ?>
						value="normal" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='jaw_jerk1' onclick="uncheck('jaw_jerk', 1)"
						name="jaw_jerk"
						<?php if(isset($check_jaw_jerk_increased)){echo $check_jaw_jerk_increased;} ?>
						value="increased" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='jaw_jerk2' onclick="uncheck('jaw_jerk', 2)"
						name="jaw_jerk"
						<?php if(isset($check_jaw_jerk_diffused)){echo $check_jaw_jerk_diffused;} ?>
						value="diffused" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='jaw_jerk3' onclick="uncheck('jaw_jerk', 3)"
						name="jaw_jerk"
						<?php if(isset($check_jaw_jerk_decreased)){echo $check_jaw_jerk_decreased;} ?>
						value="decreased" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='jaw_jerk4' onclick="uncheck('jaw_jerk', 4)"
						name="jaw_jerk"
						<?php if(isset($check_jaw_jerk_absent)){echo $check_jaw_jerk_absent;} ?>
						value="absent" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='jaw_jerk5' onclick="uncheck('jaw_jerk', 5)"
						name="jaw_jerk"
						<?php if(isset($check_jaw_jerk_clonus)){echo $check_jaw_jerk_clonus;} ?>
						value="clonus" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="jaw_jerk_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Biceps</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='biceps0' onclick="uncheck('biceps', 0)"
						name="biceps"
						<?php if(isset($check_biceps_normal)){echo $check_biceps_normal;} ?>
						value="normal" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='biceps1' onclick="uncheck('biceps', 1)"
						name="biceps"
						<?php if(isset($check_biceps_increased)){echo $check_biceps_increased;} ?>
						value="increased" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='biceps2' onclick="uncheck('biceps', 2)"
						name="biceps"
						<?php if(isset($check_biceps_diffused)){echo $check_biceps_diffused;} ?>
						value="diffused" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='biceps3' onclick="uncheck('biceps', 3)"
						name="biceps"
						<?php if(isset($check_biceps_decreased)){echo $check_biceps_decreased;} ?>
						value="decreased" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='biceps4' onclick="uncheck('biceps', 4)"
						name="biceps"
						<?php if(isset($check_biceps_absent)){echo $check_biceps_absent;} ?>
						value="absent" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='biceps5' onclick="uncheck('biceps', 5)"
						name="biceps"
						<?php if(isset($check_biceps_clonus)){echo $check_biceps_clonus;} ?>
						value="clonus" /></td>
					<input <?php echo $disabled_tous;?> type="hidden" id="biceps_temp"
						value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Finger flexor</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='finger_flexor0'
						onclick="uncheck('finger_flexor', 0)" name="finger_flexor"
						<?php if(isset($check_finger_flexor_normal)){echo $check_finger_flexor_normal;} ?>
						value="normal" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='finger_flexor1'
						onclick="uncheck('finger_flexor', 1)" name="finger_flexor"
						<?php if(isset($check_finger_flexor_increased)){echo $check_finger_flexor_increased;} ?>
						value="increased" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='finger_flexor2'
						onclick="uncheck('finger_flexor', 2)" name="finger_flexor"
						<?php if(isset($check_finger_flexor_diffused)){echo $check_finger_flexor_diffused;} ?>
						value="diffused" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='finger_flexor3'
						onclick="uncheck('finger_flexor', 3)" name="finger_flexor"
						<?php if(isset($check_finger_flexor_decreased)){echo $check_finger_flexor_decreased;} ?>
						value="decreased" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='finger_flexor4'
						onclick="uncheck('finger_flexor', 4)" name="finger_flexor"
						<?php if(isset($check_finger_flexor_absent)){echo $check_finger_flexor_absent;} ?>
						value="absent" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='finger_flexor5'
						onclick="uncheck('finger_flexor', 5)" name="finger_flexor"
						<?php if(isset($check_finger_flexor_clonus)){echo $check_finger_flexor_clonus;} ?>
						value="clonus" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="finger_flexor_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Patellar</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='patellar0' onclick="uncheck('patellar', 0)"
						name="patellar"
						<?php if(isset($check_patellar_normal)){echo $check_patellar_normal;} ?>
						value="normal" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='patellar1' onclick="uncheck('patellar', 1)"
						name="patellar"
						<?php if(isset($check_patellar_increased)){echo $check_patellar_increased;} ?>
						value="increased" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='patellar2' onclick="uncheck('patellar', 2)"
						name="patellar"
						<?php if(isset($check_patellar_diffused)){echo $check_patellar_diffused;} ?>
						value="diffused" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='patellar3' onclick="uncheck('patellar', 3)"
						name="patellar"
						<?php if(isset($check_patellar_decreased)){echo $check_patellar_decreased;} ?>
						value="decreased" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='patellar4' onclick="uncheck('patellar', 4)"
						name="patellar"
						<?php if(isset($check_patellar_absent)){echo $check_patellar_absent;} ?>
						value="absent" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='patellar5' onclick="uncheck('patellar', 5)"
						name="patellar"
						<?php if(isset($check_patellar_clonus)){echo $check_patellar_clonus;} ?>
						value="clonus" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="patellar_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Adductor</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='adductor0' onclick="uncheck('adductor', 0)"
						name="adductor"
						<?php if(isset($check_adductor_normal)){echo $check_adductor_normal;} ?>
						value="normal" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='adductor1' onclick="uncheck('adductor', 1)"
						name="adductor"
						<?php if(isset($check_adductor_increased)){echo $check_adductor_increased;} ?>
						value="increased" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='adductor2' onclick="uncheck('adductor', 2)"
						name="adductor"
						<?php if(isset($check_adductor_diffused)){echo $check_adductor_diffused;} ?>
						value="diffused" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='adductor3' onclick="uncheck('adductor', 3)"
						name="adductor"
						<?php if(isset($check_adductor_decreased)){echo $check_adductor_decreased;} ?>
						value="decreased" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='adductor4' onclick="uncheck('adductor', 4)"
						name="adductor"
						<?php if(isset($check_adductor_absent)){echo $check_adductor_absent;} ?>
						value="absent" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='adductor5' onclick="uncheck('adductor', 5)"
						name="adductor"
						<?php if(isset($check_adductor_clonus)){echo $check_adductor_clonus;} ?>
						value="clonus" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="adductor_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Ankle</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='ankle0' onclick="uncheck('ankle', 0)"
						name="ankle"
						<?php if(isset($check_ankle_normal)){echo $check_ankle_normal;} ?>
						value="normal" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='ankle1' onclick="uncheck('ankle', 1)"
						name="ankle"
						<?php if(isset($check_ankle_increased)){echo $check_ankle_increased;} ?>
						value="increased" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='ankle2' onclick="uncheck('ankle', 2)"
						name="ankle"
						<?php if(isset($check_ankle_diffused)){echo $check_ankle_diffused;} ?>
						value="diffused" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='ankle3' onclick="uncheck('ankle', 3)"
						name="ankle"
						<?php if(isset($check_ankle_decreased)){echo $check_ankle_decreased;} ?>
						value="decreased" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='ankle4' onclick="uncheck('ankle', 4)"
						name="ankle"
						<?php if(isset($check_ankle_absent)){echo $check_ankle_absent;} ?>
						value="absent" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='ankle5' onclick="uncheck('ankle', 5)"
						name="ankle"
						<?php if(isset($check_ankle_clonus)){echo $check_ankle_clonus;} ?>
						value="clonus" /></td>
					<input <?php echo $disabled_tous;?> type="hidden" id="ankle_temp"
						value='' />
				</tr>

				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td></td>
				</tr>
				<tr>
					<td></td>
					<td><b> Absent </b></td>
					<td><b> Present </b></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Hoffmann s sign</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='hoffmans_sign0' onclick="uncheck('hoffmans_sign', 0)"
						name="hoffmans_sign"
						<?php if(isset($check_hoffmans_sign_absent)){echo $check_hoffmans_sign_absent;} ?>
						value="absent" /></td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='hoffmans_sign1' onclick="uncheck('hoffmans_sign', 1)"
						name="hoffmans_sign"
						<?php if(isset($check_hoffmans_sign_present)){echo $check_hoffmans_sign_present;} ?>
						value="present" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="hoffmans_sign_temp" value='' />
				</tr>

				<tr>
					<td></td>
					<td><b> Flexor </b></td>
					<td><b> Indifferent </b></td>
					<td><b> Unilat. </b></td>
					<td><b> Bilat. </b></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Plantar reflex</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='plantar_reflex0' onclick="uncheck('plantar_reflex', 0)"
						name="plantar_reflex"
						<?php if(isset($check_plantar_reflex_flexor)){echo $check_plantar_reflex_flexor;} ?>
						value="flexor" /></td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='plantar_reflex1' onclick="uncheck('plantar_reflex', 1)"
						name="plantar_reflex"
						<?php if(isset($check_plantar_reflex_indifferent)){echo $check_plantar_reflex_indifferent;} ?>
						value="indifferent" /></td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='plantar_reflex2' onclick="uncheck('plantar_reflex', 2)"
						name="plantar_reflex"
						<?php if(isset($check_plantar_reflex_unilat)){echo $check_plantar_reflex_unilat;} ?>
						value="unilateral_extensor" /></td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='plantar_reflex3' onclick="uncheck('plantar_reflex', 3)"
						name="plantar_reflex"
						<?php if(isset($check_plantar_reflex_bilat)){echo $check_plantar_reflex_bilat;} ?>
						value="bilateral_extensor" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="plantar_reflex_temp" value='' />
					<input <?php echo $disabled_tous;?> type="hidden"
						id="plantar_reflex_right_left_temp" value='' />
				</tr>
			</table>

		</td>


		<td>
			<table class="secondaire">
				<tr>
					<td colspan="4"><p style="">
							<b> 2. Motor deficit</b>
						</p></td>
				</tr>
				<tr>
					<td></td>
					<td><b> None </b></td>
					<td><b> Mild 4/5 </b></td>
					<td><b> Moderate 2-3/5 </b></td>
					<td><b> Severe &#139;2/5 </b></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Facial palsy/ atrophy</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_facial_palsy_atrophy0'
						onclick="uncheck('motor_facial_palsy_atrophy', 0)"
						name="motor_facial_palsy_atrophy"
						<?php if(isset($check_motor_facial_palsy_atrophy_none)){echo $check_motor_facial_palsy_atrophy_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_facial_palsy_atrophy1'
						onclick="uncheck('motor_facial_palsy_atrophy', 1)"
						name="motor_facial_palsy_atrophy"
						<?php if(isset($check_motor_facial_palsy_atrophy_mild)){echo $check_motor_facial_palsy_atrophy_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_facial_palsy_atrophy2'
						onclick="uncheck('motor_facial_palsy_atrophy', 2)"
						name="motor_facial_palsy_atrophy"
						<?php if(isset($check_motor_facial_palsy_atrophy_moderate)){echo $check_motor_facial_palsy_atrophy_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_facial_palsy_atrophy3'
						onclick="uncheck('motor_facial_palsy_atrophy', 3)"
						name="motor_facial_palsy_atrophy"
						<?php if(isset($check_motor_facial_palsy_atrophy_severe)){echo $check_motor_facial_palsy_atrophy_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="motor_facial_palsy_atrophy_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Proximal UL</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_proximal_UL0'
						onclick="uncheck('motor_proximal_UL', 0)" name="motor_proximal_UL"
						<?php if(isset($check_motor_proximal_UL_none)){echo $check_motor_proximal_UL_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_proximal_UL1'
						onclick="uncheck('motor_proximal_UL', 1)" name="motor_proximal_UL"
						<?php if(isset($check_motor_proximal_UL_mild)){echo $check_motor_proximal_UL_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_proximal_UL2'
						onclick="uncheck('motor_proximal_UL', 2)" name="motor_proximal_UL"
						<?php if(isset($check_motor_proximal_UL_moderate)){echo $check_motor_proximal_UL_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_proximal_UL3'
						onclick="uncheck('motor_proximal_UL', 3)" name="motor_proximal_UL"
						<?php if(isset($check_motor_proximal_UL_severe)){echo $check_motor_proximal_UL_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="motor_proximal_UL_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Distal UL</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_distal_UL0'
						onclick="uncheck('motor_distal_UL', 0)" name="motor_distal_UL"
						<?php if(isset($check_motor_distal_UL_none)){echo $check_motor_distal_UL_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_distal_UL1'
						onclick="uncheck('motor_distal_UL', 1)" name="motor_distal_UL"
						<?php if(isset($check_motor_distal_UL_mild)){echo $check_motor_distal_UL_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_distal_UL2'
						onclick="uncheck('motor_distal_UL', 2)" name="motor_distal_UL"
						<?php if(isset($check_motor_distal_UL_moderate)){echo $check_motor_distal_UL_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_distal_UL3'
						onclick="uncheck('motor_distal_UL', 3)" name="motor_distal_UL"
						<?php if(isset($check_motor_distal_UL_severe)){echo $check_motor_distal_UL_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="motor_distal_UL_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Proximal LL</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_proximal_LL0'
						onclick="uncheck('motor_proximal_LL', 0)" name="motor_proximal_LL"
						<?php if(isset($check_motor_proximal_LL_none)){echo $check_motor_proximal_LL_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_proximal_LL1'
						onclick="uncheck('motor_proximal_LL', 1)" name="motor_proximal_LL"
						<?php if(isset($check_motor_proximal_LL_mild)){echo $check_motor_proximal_LL_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_proximal_LL2'
						onclick="uncheck('motor_proximal_LL', 2)" name="motor_proximal_LL"
						<?php if(isset($check_motor_proximal_LL_moderate)){echo $check_motor_proximal_LL_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_proximal_LL3'
						onclick="uncheck('motor_proximal_LL', 3)" name="motor_proximal_LL"
						<?php if(isset($check_motor_proximal_LL_severe)){echo $check_motor_proximal_LL_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="motor_proximal_LL_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Distal LL</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_distal_LL0'
						onclick="uncheck('motor_distal_LL', 0)" name="motor_distal_LL"
						<?php if(isset($check_motor_distal_LL_none)){echo $check_motor_distal_LL_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_distal_LL1'
						onclick="uncheck('motor_distal_LL', 1)" name="motor_distal_LL"
						<?php if(isset($check_motor_distal_LL_mild)){echo $check_motor_distal_LL_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_distal_LL2'
						onclick="uncheck('motor_distal_LL', 2)" name="motor_distal_LL"
						<?php if(isset($check_motor_distal_LL_moderate)){echo $check_motor_distal_LL_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='motor_distal_LL3'
						onclick="uncheck('motor_distal_LL', 3)" name="motor_distal_LL"
						<?php if(isset($check_motor_distal_LL_severe)){echo $check_motor_distal_LL_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="motor_distal_LL_temp" value='' />
				</tr>
			</table>
		</td>
	</tr>

	<tr>
		<td>
			<table class="secondaire">
				<tr></tr>
				<td colspan="4"><p style="">
						<b> 3. Muscle wasting </b>
					</p></td>
				</tr>
				<tr>
					<td></td>
					<td><b> None </b></td>
					<td><b> Mild </b></td>
					<td><b> Moderate </b></td>
					<td><b> Severe </b></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Proximal UL</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_proximal_UL0'
						onclick="uncheck('muscle_proximal_UL', 0)"
						name="muscle_proximal_UL"
						<?php if(isset($check_muscle_proximal_UL_none)){echo $check_muscle_proximal_UL_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_proximal_UL1'
						onclick="uncheck('muscle_proximal_UL', 1)"
						name="muscle_proximal_UL"
						<?php if(isset($check_muscle_proximal_UL_mild)){echo $check_muscle_proximal_UL_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_proximal_UL2'
						onclick="uncheck('muscle_proximal_UL', 2)"
						name="muscle_proximal_UL"
						<?php if(isset($check_muscle_proximal_UL_moderate)){echo $check_muscle_proximal_UL_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_proximal_UL3'
						onclick="uncheck('muscle_proximal_UL', 3)"
						name="muscle_proximal_UL"
						<?php if(isset($check_muscle_proximal_UL_severe)){echo $check_muscle_proximal_UL_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="muscle_proximal_UL_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Distal UL</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_distal_UL0'
						onclick="uncheck('muscle_distal_UL', 0)" name="muscle_distal_UL"
						<?php if(isset($check_muscle_distal_UL_none)){echo $check_muscle_distal_UL_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_distal_UL1'
						onclick="uncheck('muscle_distal_UL', 1)" name="muscle_distal_UL"
						<?php if(isset($check_muscle_distal_UL_mild)){echo $check_muscle_distal_UL_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_distal_UL2'
						onclick="uncheck('muscle_distal_UL', 2)" name="muscle_distal_UL"
						<?php if(isset($check_muscle_distal_UL_moderate)){echo $check_muscle_distal_UL_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_distal_UL3'
						onclick="uncheck('muscle_distal_UL', 3)" name="muscle_distal_UL"
						<?php if(isset($check_muscle_distal_UL_severe)){echo $check_muscle_distal_UL_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="muscle_distal_UL_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Proximal LL</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_proximal_LL0'
						onclick="uncheck('muscle_proximal_LL', 0)"
						name="muscle_proximal_LL"
						<?php if(isset($check_muscle_proximal_LL_none)){echo $check_muscle_proximal_LL_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_proximal_LL1'
						onclick="uncheck('muscle_proximal_LL', 1)"
						name="muscle_proximal_LL"
						<?php if(isset($check_muscle_proximal_LL_mild)){echo $check_muscle_proximal_LL_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_proximal_LL2'
						onclick="uncheck('muscle_proximal_LL', 2)"
						name="muscle_proximal_LL"
						<?php if(isset($check_muscle_proximal_LL_moderate)){echo $check_muscle_proximal_LL_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_proximal_LL3'
						onclick="uncheck('muscle_proximal_LL', 3)"
						name="muscle_proximal_LL"
						<?php if(isset($check_muscle_proximal_LL_severe)){echo $check_muscle_proximal_LL_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="muscle_proximal_LL_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Distal LL</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_distal_LL0'
						onclick="uncheck('muscle_distal_LL', 0)" name="muscle_distal_LL"
						<?php if(isset($check_muscle_distal_LL_none)){echo $check_muscle_distal_LL_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_distal_LL1'
						onclick="uncheck('muscle_distal_LL', 1)" name="muscle_distal_LL"
						<?php if(isset($check_muscle_distal_LL_mild)){echo $check_muscle_distal_LL_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_distal_LL2'
						onclick="uncheck('muscle_distal_LL', 2)" name="muscle_distal_LL"
						<?php if(isset($check_muscle_distal_LL_moderate)){echo $check_muscle_distal_LL_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='muscle_distal_LL3'
						onclick="uncheck('muscle_distal_LL', 3)" name="muscle_distal_LL"
						<?php if(isset($check_muscle_distal_LL_severe)){echo $check_muscle_distal_LL_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="muscle_distal_LL_temp" value='' />
				</tr>
			</table>
		</td>

		<td>
			<table class="secondaire">
				<tr>
					<td colspan="4"><p style="">
							<b> 4. Fasciculations or Myokymias (Facial contraction
								fasciculations) please circle </b>
						</p></td>
				</tr>
				<tr>
					<td></td>
					<td>No</td>
					<td>Yes</td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Fasciculations</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='fasciculations0' onclick="uncheck('fasciculations', 0)"
						name="fasciculations"
						<?php if(isset($check_fasciculations_no)){echo $check_fasciculations_no;} ?>
						value="no" /></td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='fasciculations1' onclick="uncheck('fasciculations', 1)"
						name="fasciculations"
						<?php if(isset($check_fasciculations_yes)){echo $check_fasciculations_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="fasciculations_temp" value='' />
					<td colspan="4">Localisation : <input <?php echo $disabled_tous;?>
						type="text" style="width: 200px;"
						name="fasciculations_localisation"
						value="<?php echo $hash_champ_valeur['fasciculations_localisation']; ?>" /></td>
				</tr>

				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Myokymias</td>
					</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='myokymias0' onclick="uncheck('myokymias', 0)" name="myokymias"
						<?php if(isset($check_myokymias_no)){echo $check_myokymias_no;} ?>
						value="no" /></td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='myokymias1' onclick="uncheck('myokymias', 1)" name="myokymias"
						<?php if(isset($check_myokymias_yes)){echo $check_myokymias_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="myokymias_temp" value='' />
					<td colspan="4">Localisation : <input <?php echo $disabled_tous;?>
						type="text" style="width: 200px;" name="myokymias_localisation"
						value="<?php echo $hash_champ_valeur['myokymias_localisation']; ?>" /></td>
				</tr>

			</table>
		</td>
	</tr>

	<tr>
		<td>
			<table class="secondaire">
				<tr>
					<td colspan="4"><p style="">
							<b> 5. Sensory deficit </b>
						</p></td>
				</tr>
				<tr>
					<td></td>
					<td>None 8/8</td>
					<td>Mild >5/8</td>
					<td>Moderate 2-5/8</td>
					<td>Severe &#139;2/8</td>
					<td>Abolished 0/8</td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Vibration sense (ankles)</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='vibration_sense0' onclick="uncheck('vibration_sense', 0)"
						name="vibration_sense"
						<?php if(isset($check_vibration_sense_none)){echo $check_vibration_sense_none;} ?>
						value="none" /></td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='vibration_sense1' onclick="uncheck('vibration_sense', 1)"
						name="vibration_sense"
						<?php if(isset($check_vibration_sense_mild)){echo $check_vibration_sense_mild;} ?>
						value="mild" /></td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='vibration_sense2' onclick="uncheck('vibration_sense', 2)"
						name="vibration_sense"
						<?php if(isset($check_vibration_sense_moderate)){echo $check_vibration_sense_moderate;} ?>
						value="moderate" /></td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='vibration_sense3' onclick="uncheck('vibration_sense', 3)"
						name="vibration_sense"
						<?php if(isset($check_vibration_sense_severe)){echo $check_vibration_sense_severe;} ?>
						value="severe" /></td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='vibration_sense4' onclick="uncheck('vibration_sense', 4)"
						name="vibration_sense"
						<?php if(isset($check_vibration_sense_abolished)){echo $check_vibration_sense_abolished;} ?>
						value="abolished" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="vibration_sense_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Superficial sensory loss</td>
					<td><label>No<br /> <input <?php echo $disabled_tous;?>
							type="checkbox" name="superficial_sensory_loss[]"
							<?php if(isset($hash_champ_valeur['superficial_sensory_loss']) and preg_match("/no/", $hash_champ_valeur['superficial_sensory_loss'])){ echo " checked='checked'"; } ?>
							value="no"></label></td>
					<td><label>Touch<br /> <input <?php echo $disabled_tous;?>
							type="checkbox" name="superficial_sensory_loss[]"
							<?php if(isset($hash_champ_valeur['superficial_sensory_loss']) and preg_match("/touch/", $hash_champ_valeur['superficial_sensory_loss'])){ echo " checked='checked'"; } ?>
							value="touch"></label></td>
					<td><label>Prick<br /> <input <?php echo $disabled_tous;?>
							type="checkbox" name="superficial_sensory_loss[]"
							<?php if(isset($hash_champ_valeur['superficial_sensory_loss']) and preg_match("/prick/", $hash_champ_valeur['superficial_sensory_loss'])){ echo " checked='checked'"; } ?>
							value="prick"></label></td>
					<td><label>Cold<br /> <input <?php echo $disabled_tous;?>
							type="checkbox" name="superficial_sensory_loss[]"
							<?php if(isset($hash_champ_valeur['superficial_sensory_loss']) and preg_match("/cold/", $hash_champ_valeur['superficial_sensory_loss'])){ echo " checked='checked'"; } ?>
							value="cold"></label></td>
				</tr>

				<input <?php echo $disabled_tous;?> type="hidden"
					id="superficial_sensory_loss_temp" value='' />

				</tr>
			</table>
		</td>


		<td>
			<table class="secondaire">
				<tr>
					<td colspan="4"><p style="">
							<b> 6. Skeletal abnormalities </b>
						</p></td>
				</tr>
				<tr>
					<td></td>
					<td><b> None </b></td>
					<td><b> Mild </b></td>
					<td><b> Moderate </b></td>
					<td><b> Severe </b></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Scoliosis</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='scoliosis0' onclick="uncheck('scoliosis', 0)"
						name="scoliosis"
						<?php if(isset($check_scoliosis_none)){echo $check_scoliosis_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='scoliosis1' onclick="uncheck('scoliosis', 1)"
						name="scoliosis"
						<?php if(isset($check_scoliosis_mild)){echo $check_scoliosis_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='scoliosis2' onclick="uncheck('scoliosis', 2)"
						name="scoliosis"
						<?php if(isset($check_scoliosis_moderate)){echo $check_scoliosis_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='scoliosis3' onclick="uncheck('scoliosis', 3)"
						name="scoliosis"
						<?php if(isset($check_scoliosis_severe)){echo $check_scoliosis_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="scoliosis_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Pes cavus</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='pes_cavus0' onclick="uncheck('pes_cavus', 0)"
						name="pes_cavus"
						<?php if(isset($check_pes_cavus_none)){echo $check_pes_cavus_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='pes_cavus1' onclick="uncheck('pes_cavus', 1)"
						name="pes_cavus"
						<?php if(isset($check_pes_cavus_mild)){echo $check_pes_cavus_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='pes_cavus2' onclick="uncheck('pes_cavus', 2)"
						name="pes_cavus"
						<?php if(isset($check_pes_cavus_moderate)){echo $check_pes_cavus_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='pes_cavus3' onclick="uncheck('pes_cavus', 3)"
						name="pes_cavus"
						<?php if(isset($check_pes_cavus_severe)){echo $check_pes_cavus_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="pes_cavus_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Other <input <?php echo $disabled_tous;?> type="text"
						style="width: 200px;" name="other_other_skeletal_abnormality"
						value="<?php echo $hash_champ_valeur['other_other_skeletal_abnormality']; ?>" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='other_skeletal_abnormality0'
						onclick="uncheck('other_skeletal_abnormality', 0)"
						name="other_skeletal_abnormality"
						<?php if(isset($check_other_skeletal_abnormality_none)){echo $check_other_skeletal_abnormality_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='other_skeletal_abnormality1'
						onclick="uncheck('other_skeletal_abnormality', 1)"
						name="other_skeletal_abnormality"
						<?php if(isset($check_other_skeletal_abnormality_mild)){echo $check_other_skeletal_abnormality_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='other_skeletal_abnormality2'
						onclick="uncheck('other_skeletal_abnormality', 2)"
						name="other_skeletal_abnormality"
						<?php if(isset($check_other_skeletal_abnormality_moderate)){echo $check_other_skeletal_abnormality_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='other_skeletal_abnormality3'
						onclick="uncheck('other_skeletal_abnormality', 3)"
						name="other_skeletal_abnormality"
						<?php if(isset($check_other_skeletal_abnormality_severe)){echo $check_other_skeletal_abnormality_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="other_skeletal_abnormality_temp" value='' />
				</tr>
			</table>
		</td>
	</tr>

	<tr>
		<td>
			<table class="secondaire">
				<tr>
					<td colspan="4"><p style="">
							<b> 7. Facial dysmorphia </b>
						</p></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='facial_dysmorphia0' onclick="uncheck('facial_dysmorphia', 0)"
						name="facial_dysmorphia"
						<?php if(isset($check_facial_dysmorphia_no)){echo $check_facial_dysmorphia_no;} ?>
						value="no" /> No</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='facial_dysmorphia1' onclick="uncheck('facial_dysmorphia', 1)"
						name="facial_dysmorphia"
						<?php if(isset($check_facial_dysmorphia_yes)){echo $check_facial_dysmorphia_yes;} ?>
						value="yes" /> Yes</td>
				</tr>
				<input <?php echo $disabled_tous;?> type="hidden"
					id="facial_dysmorphia_temp" value='' />
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td colspan="2">Describe : <input <?php echo $disabled_tous;?>
						type="text" style="width: 200px;"
						name="describe_facial_dysmorphia"
						value="<?php echo $hash_champ_valeur['describe_facial_dysmorphia']; ?>" /></td>
				</tr>
			</table>
		</td>

		<td>
			<table class="secondaire">
				<tr>
					<td colspan="4"><p style="">
							<b> 8. Sphincter and sexual disturbances </b>
						</p></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td></td>
					<td><b> None </b></td>
					<td><b> Mild </b></td>
					<td><b> Moderate </b></td>
					<td><b> Severe </b></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Urinary urgency</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='urinary_urgency0'
						onclick="uncheck('urinary_urgency', 0)" name="urinary_urgency"
						<?php if(isset($check_urinary_urgency_none)){echo $check_urinary_urgency_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='urinary_urgency1'
						onclick="uncheck('urinary_urgency', 1)" name="urinary_urgency"
						<?php if(isset($check_urinary_urgency_mild)){echo $check_urinary_urgency_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='urinary_urgency2'
						onclick="uncheck('urinary_urgency', 2)" name="urinary_urgency"
						<?php if(isset($check_urinary_urgency_moderate)){echo $check_urinary_urgency_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='urinary_urgency3'
						onclick="uncheck('urinary_urgency', 3)" name="urinary_urgency"
						<?php if(isset($check_urinary_urgency_severe)){echo $check_urinary_urgency_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="urinary_urgency_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Urinary incontinence</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='urinary_incontinence0'
						onclick="uncheck('urinary_incontinence', 0)"
						name="urinary_incontinence"
						<?php if(isset($check_urinary_incontinence_none)){echo $check_urinary_incontinence_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='urinary_incontinence1'
						onclick="uncheck('urinary_incontinence', 1)"
						name="urinary_incontinence"
						<?php if(isset($check_urinary_incontinence_mild)){echo $check_urinary_incontinence_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='urinary_incontinence2'
						onclick="uncheck('urinary_incontinence', 2)"
						name="urinary_incontinence"
						<?php if(isset($check_urinary_incontinence_moderate)){echo $check_urinary_incontinence_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='urinary_incontinence3'
						onclick="uncheck('urinary_incontinence', 3)"
						name="urinary_incontinence"
						<?php if(isset($check_urinary_incontinence_severe)){echo $check_urinary_incontinence_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="urinary_incontinence_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Urinary retention</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='urinary_retention0'
						onclick="uncheck('urinary_retention', 0)" name="urinary_retention"
						<?php if(isset($check_urinary_retention_none)){echo $check_urinary_retention_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='urinary_retention1'
						onclick="uncheck('urinary_retention', 1)" name="urinary_retention"
						<?php if(isset($check_urinary_retention_mild)){echo $check_urinary_retention_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='urinary_retention2'
						onclick="uncheck('urinary_retention', 2)" name="urinary_retention"
						<?php if(isset($check_urinary_retention_moderate)){echo $check_urinary_retention_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='urinary_retention3'
						onclick="uncheck('urinary_retention', 3)" name="urinary_retention"
						<?php if(isset($check_urinary_retention_severe)){echo $check_urinary_retention_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="urinary_retention_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Anal incontinence</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='anal_incontinence0'
						onclick="uncheck('anal_incontinence', 0)" name="anal_incontinence"
						<?php if(isset($check_anal_incontinence_none)){echo $check_anal_incontinence_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='anal_incontinence1'
						onclick="uncheck('anal_incontinence', 1)" name="anal_incontinence"
						<?php if(isset($check_anal_incontinence_mild)){echo $check_anal_incontinence_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='anal_incontinence2'
						onclick="uncheck('anal_incontinence', 2)" name="anal_incontinence"
						<?php if(isset($check_anal_incontinence_moderate)){echo $check_anal_incontinence_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='anal_incontinence3'
						onclick="uncheck('anal_incontinence', 3)" name="anal_incontinence"
						<?php if(isset($check_anal_incontinence_severe)){echo $check_anal_incontinence_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="anal_incontinence_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Impaired sexual function</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='impaired_sexual_function0'
						onclick="uncheck('impaired_sexual_function', 0)"
						name="impaired_sexual_function"
						<?php if(isset($check_impaired_sexual_function_none)){echo $check_impaired_sexual_function_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='impaired_sexual_function1'
						onclick="uncheck('impaired_sexual_function', 1)"
						name="impaired_sexual_function"
						<?php if(isset($check_impaired_sexual_function_mild)){echo $check_impaired_sexual_function_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='impaired_sexual_function2'
						onclick="uncheck('impaired_sexual_function', 2)"
						name="impaired_sexual_function"
						<?php if(isset($check_impaired_sexual_function_moderate)){echo $check_impaired_sexual_function_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='impaired_sexual_function3'
						onclick="uncheck('impaired_sexual_function', 3)"
						name="impaired_sexual_function"
						<?php if(isset($check_impaired_sexual_function_severe)){echo $check_impaired_sexual_function_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="impaired_sexual_function_temp" value='' />
				</tr>

				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Early menopause</td>
					<td>Yes <input <?php echo $disabled_tous;?> type="radio"
						id='early_menopause0' onclick="uncheck('early_menopause', 0)"
						name="early_menopause"
						<?php if(isset($check_early_menopause_yes)){echo $check_early_menopause_yes;} ?>
						value="yes" /></td>
					<td>No <input <?php echo $disabled_tous;?> type="radio"
						id='early_menopause1' onclick="uncheck('early_menopause', 1)"
						name="early_menopause"
						<?php if(isset($check_early_menopause_no)){echo $check_early_menopause_no;} ?>
						value="no" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="early_menopause_temp" value='' />
					<td colspan="2">At age : <input <?php echo $disabled_tous;?>
						type="text" style="width: 100px;" name="early_menopause_age"
						value="<?php echo $hash_champ_valeur['early_menopause_age']; ?>"
						onBlur="onBlurNombre(this);" /></td>
				</tr>
			</table>
		</td>
	</tr>

	<tr>
		<td>
			<table class="secondaire">
				<tr>
					<td colspan="4"><p style="">
							<b> 9. Extra-pyramidal symptoms </b>
						</p></td>
				</tr>
				<tr>
					<td></td>
					<td><b> None </b></td>
					<td><b> Mild </b></td>
					<td><b> Moderate </b></td>
					<td><b> Severe </b></td>
					<td><b> Specify </b></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Resting tremor</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='resting_tremor0'
						onclick="uncheck('resting_tremor', 0)" name="resting_tremor"
						<?php if(isset($check_resting_tremor_none)){echo $check_resting_tremor_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='resting_tremor1'
						onclick="uncheck('resting_tremor', 1)" name="resting_tremor"
						<?php if(isset($check_resting_tremor_mild)){echo $check_resting_tremor_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='resting_tremor2'
						onclick="uncheck('resting_tremor', 2)" name="resting_tremor"
						<?php if(isset($check_resting_tremor_moderate)){echo $check_resting_tremor_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='resting_tremor3'
						onclick="uncheck('resting_tremor', 3)" name="resting_tremor"
						<?php if(isset($check_resting_tremor_severe)){echo $check_resting_tremor_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="resting_tremor_temp" value='' />
					<td><input <?php echo $disabled_tous;?> type="text"
						style="width: 100px;" name="specify_resting_tremor"
						value="<?php echo $hash_champ_valeur['specify_resting_tremor']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Postural tremor</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='postural_tremor0'
						onclick="uncheck('postural_tremor', 0)" name="postural_tremor"
						<?php if(isset($check_postural_tremor_none)){echo $check_postural_tremor_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='postural_tremor1'
						onclick="uncheck('postural_tremor', 1)" name="postural_tremor"
						<?php if(isset($check_postural_tremor_mild)){echo $check_postural_tremor_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='postural_tremor2'
						onclick="uncheck('postural_tremor', 2)" name="postural_tremor"
						<?php if(isset($check_postural_tremor_moderate)){echo $check_postural_tremor_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='postural_tremor3'
						onclick="uncheck('postural_tremor', 3)" name="postural_tremor"
						<?php if(isset($check_postural_tremor_severe)){echo $check_postural_tremor_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="postural_tremor_temp" value='' />
					<td><input <?php echo $disabled_tous;?> type="text"
						style="width: 100px;" name="specify_postural_tremor"
						value="<?php echo $hash_champ_valeur['specify_postural_tremor']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Chorea</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='chorea0' onclick="uncheck('chorea', 0)"
						name="chorea"
						<?php if(isset($check_chorea_none)){echo $check_chorea_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='chorea1' onclick="uncheck('chorea', 1)"
						name="chorea"
						<?php if(isset($check_chorea_mild)){echo $check_chorea_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='chorea2' onclick="uncheck('chorea', 2)"
						name="chorea"
						<?php if(isset($check_chorea_moderate)){echo $check_chorea_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='chorea3' onclick="uncheck('chorea', 3)"
						name="chorea"
						<?php if(isset($check_chorea_severe)){echo $check_chorea_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden" id="chorea_temp"
						value='' />
					<td><input <?php echo $disabled_tous;?> type="text"
						style="width: 100px;" name="specify_chorea"
						value="<?php echo $hash_champ_valeur['specify_chorea']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Dystonia</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='dystonia0' onclick="uncheck('dystonia', 0)"
						name="dystonia"
						<?php if(isset($check_dystonia_none)){echo $check_dystonia_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='dystonia1' onclick="uncheck('dystonia', 1)"
						name="dystonia"
						<?php if(isset($check_dystonia_mild)){echo $check_dystonia_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='dystonia2' onclick="uncheck('dystonia', 2)"
						name="dystonia"
						<?php if(isset($check_dystonia_moderate)){echo $check_dystonia_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='dystonia3' onclick="uncheck('dystonia', 3)"
						name="dystonia"
						<?php if(isset($check_dystonia_severe)){echo $check_dystonia_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="dystonia_temp" value='' />
					<td><input <?php echo $disabled_tous;?> type="text"
						style="width: 100px;" name="specify_dystonia"
						value="<?php echo $hash_champ_valeur['specify_dystonia']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Myoclonus</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='myoclonus0' onclick="uncheck('myoclonus', 0)"
						name="myoclonus"
						<?php if(isset($check_myoclonus_none)){echo $check_myoclonus_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='myoclonus1' onclick="uncheck('myoclonus', 1)"
						name="myoclonus"
						<?php if(isset($check_myoclonus_mild)){echo $check_myoclonus_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='myoclonus2' onclick="uncheck('myoclonus', 2)"
						name="myoclonus"
						<?php if(isset($check_myoclonus_moderate)){echo $check_myoclonus_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='myoclonus3' onclick="uncheck('myoclonus', 3)"
						name="myoclonus"
						<?php if(isset($check_myoclonus_severe)){echo $check_myoclonus_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="myoclonus_temp" value='' />
					<td><input <?php echo $disabled_tous;?> type="text"
						style="width: 100px;" name="specify_myoclonus"
						value="<?php echo $hash_champ_valeur['specify_myoclonus']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Hypokinesia</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='hypokinesia0' onclick="uncheck('hypokinesia', 0)"
						name="hypokinesia"
						<?php if(isset($check_hypokinesia_none)){echo $check_hypokinesia_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='hypokinesia1' onclick="uncheck('hypokinesia', 1)"
						name="hypokinesia"
						<?php if(isset($check_hypokinesia_mild)){echo $check_hypokinesia_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='hypokinesia2' onclick="uncheck('hypokinesia', 2)"
						name="hypokinesia"
						<?php if(isset($check_hypokinesia_moderate)){echo $check_hypokinesia_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='hypokinesia3' onclick="uncheck('hypokinesia', 3)"
						name="hypokinesia"
						<?php if(isset($check_hypokinesia_severe)){echo $check_hypokinesia_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="hypokinesia_temp" value='' />
					<td><input <?php echo $disabled_tous;?> type="text"
						style="width: 100px;" name="specify_hypokinesia"
						value="<?php echo $hash_champ_valeur['specify_hypokinesia']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Rigidity</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='rigidity0' onclick="uncheck('rigidity', 0)"
						name="rigidity"
						<?php if(isset($check_rigidity_none)){echo $check_rigidity_none;} ?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='rigidity1' onclick="uncheck('rigidity', 1)"
						name="rigidity"
						<?php if(isset($check_rigidity_mild)){echo $check_rigidity_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='rigidity2' onclick="uncheck('rigidity', 2)"
						name="rigidity"
						<?php if(isset($check_rigidity_moderate)){echo $check_rigidity_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='rigidity3' onclick="uncheck('rigidity', 3)"
						name="rigidity"
						<?php if(isset($check_rigidity_severe)){echo $check_rigidity_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="rigidity_temp" value='' />
					<td><input <?php echo $disabled_tous;?> type="text"
						style="width: 100px;" name="specify_rigidity"
						value="<?php echo $hash_champ_valeur['specify_rigidity']; ?>" /></td>
				</tr>
			</table>
		</td>


		<td>
			<table class="secondaire">
				<tr>
					<td colspan="4"><p style="">
							<b> 10. Ophtalmological signs </b>
						</p></td>
				</tr>
				<tr>
					<td></td>
					<td><b> No </b></td>
					<td><b> Yes </b></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Diplopia</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='diplopia0' onclick="uncheck('diplopia', 0)"
						name="diplopia"
						<?php if(isset($check_diplopia_no)){echo $check_diplopia_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='diplopia1' onclick="uncheck('diplopia', 1)"
						name="diplopia"
						<?php if(isset($check_diplopia_yes)){echo $check_diplopia_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="diplopia_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Ptosis</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='ptosis0' onclick="uncheck('ptosis', 0)"
						name="ptosis"
						<?php if(isset($check_ptosis_no)){echo $check_ptosis_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='ptosis1' onclick="uncheck('ptosis', 1)"
						name="ptosis"
						<?php if(isset($check_ptosis_yes)){echo $check_ptosis_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden" id="ptosis_temp"
						value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Eye lid retraction (bulging eyes)</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='bulging_eyes0'
						onclick="uncheck('bulging_eyes', 0)" name="bulging_eyes"
						<?php if(isset($check_bulging_eyes_no)){echo $check_bulging_eyes_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='bulging_eyes1'
						onclick="uncheck('bulging_eyes', 1)" name="bulging_eyes"
						<?php if(isset($check_bulging_eyes_yes)){echo $check_bulging_eyes_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="bulging_eyes_temp" value='' />
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Diminished visual acuity</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='diminished_visual_acuity0'
						onclick="uncheck('diminished_visual_acuity', 0)"
						name="diminished_visual_acuity"
						<?php if(isset($check_diminished_visual_acuity_no)){echo $check_diminished_visual_acuity_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='diminished_visual_acuity1'
						onclick="uncheck('diminished_visual_acuity', 1)"
						name="diminished_visual_acuity"
						<?php if(isset($check_diminished_visual_acuity_yes)){echo $check_diminished_visual_acuity_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="diminished_visual_acuity_temp" value='' />
					<td>At age : <input <?php echo $disabled_tous;?> type="text"
						style="width: 100px;" name="diminished_visual_acuity_age"
						value="<?php echo $hash_champ_valeur['diminished_visual_acuity_age']; ?>"
						onBlur="onBlurNombre(this);" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td></td>
				</tr>
				<tr>
					<td><b> * Fundus </b></td>
					<td>No</td>
					<td>Yes</td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Abnormal</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='abnormal_fundus0'
						onclick="uncheck('abnormal_fundus', 0)" name="abnormal_fundus"
						<?php if(isset($check_abnormal_fundus_no)){echo $check_abnormal_fundus_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='abnormal_fundus1'
						onclick="uncheck('abnormal_fundus', 1)" name="abnormal_fundus"
						<?php if(isset($check_abnormal_fundus_yes)){echo $check_abnormal_fundus_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="abnormal_fundus_temp" value='' />

					<td><label><input <?php echo $disabled_tous;?> type="radio"
							id='other_abnormal_fundus0'
							onclick="uncheck('other_abnormal_fundus', 0)"
							name="other_abnormal_fundus"
							<?php if(isset($check_other_abnormal_fundus_optic_atrophy)){echo $check_other_abnormal_fundus_optic_atrophy;} ?>
							value="optic_atrophy" /> Optic atrophy </label><br /> <label><input
							<?php echo $disabled_tous;?> type="radio"
							id='other_abnormal_fundus1'
							onclick="uncheck('other_abnormal_fundus', 1)"
							name="other_abnormal_fundus"
							<?php if(isset($check_other_abnormal_fundus_Retinis_Pigmentosa)){echo $check_other_abnormal_fundus_Retinis_Pigmentosa;} ?>
							value="retinis_pigmentosa" /><i> Retinis Pigmentosa </i></label><br />
						<input <?php echo $disabled_tous;?> type="hidden"
						id="other_abnormal_fundus_temp" value='' /> Other : <input
						<?php echo $disabled_tous;?> type="text" style="width: 200px;"
						name="other_other_abnormal_fundus"
						value="<?php echo $hash_champ_valeur['other_other_abnormal_fundus']; ?>" /></td>
				
				
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td></td>
				</tr>
				</tr>
				<tr>
					<td><b> * Oculomotor </b></td>
					<td><b> No </b></td>
					<td><b> Yes </b></td>
					<td><b> Describe </b></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Nystagmus</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='oculomotor_nystagmus0'
						onclick="uncheck('oculomotor_nystagmus', 0)"
						name="oculomotor_nystagmus"
						<?php if(isset($check_oculomotor_nystagmus_no)){echo $check_oculomotor_nystagmus_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='oculomotor_nystagmus1'
						onclick="uncheck('oculomotor_nystagmus', 1)"
						name="oculomotor_nystagmus"
						<?php if(isset($check_oculomotor_nystagmus_yes)){echo $check_oculomotor_nystagmus_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="oculomotor_nystagmus_temp" value='' />
					<td><input <?php echo $disabled_tous;?> type="text"
						style="width: 300px;" name="describe_oculomotor_nystagmus"
						value="<?php echo $hash_champ_valeur['describe_oculomotor_nystagmus']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Saccadic pursuit</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='oculomotor_saccadic_pursuit0'
						onclick="uncheck('oculomotor_saccadic_pursuit', 0)"
						name="oculomotor_saccadic_pursuit"
						<?php if(isset($check_oculomotor_saccadic_pursuit_no)){echo $check_oculomotor_saccadic_pursuit_no ;}?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='oculomotor_saccadic_pursuit1'
						onclick="uncheck('oculomotor_saccadic_pursuit', 1)"
						name="oculomotor_saccadic_pursuit"
						<?php if(isset($check_oculomotor_saccadic_pursuit_yes)){echo $check_oculomotor_saccadic_pursuit_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="oculomotor_saccadic_pursuit_temp" value='' />
					<td><input <?php echo $disabled_tous;?> type="text"
						style="width: 300px;" name="describe_oculomotor_saccadic_pursuit"
						value="<?php echo $hash_champ_valeur['describe_oculomotor_saccadic_pursuit']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Fixation instability</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='oculomotor_fixation_instability0'
						onclick="uncheck('oculomotor_fixation_instability', 0)"
						name="oculomotor_fixation_instability"
						<?php if(isset($check_oculomotor_fixation_instability_no)){echo $check_oculomotor_fixation_instability_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='oculomotor_fixation_instability1'
						onclick="uncheck('oculomotor_fixation_instability', 1)"
						name="oculomotor_fixation_instability"
						<?php if(isset($check_oculomotor_fixation_instability_yes)){echo $check_oculomotor_fixation_instability_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="oculomotor_fixation_instability_temp" value='' />
					<td><input <?php echo $disabled_tous;?> type="text"
						style="width: 300px;"
						name="describe_oculomotor_fixation_instability"
						value="<?php echo $hash_champ_valeur['describe_oculomotor_fixation_instability']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Horizontal slow saccades</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='horizontal_oculomotor_slow_saccades0'
						onclick="uncheck('horizontal_oculomotor_slow_saccades', 0)"
						name="horizontal_oculomotor_slow_saccades"
						<?php if(isset($check_horizontal_oculomotor_slow_saccades_no)){echo $check_horizontal_oculomotor_slow_saccades_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='horizontal_oculomotor_slow_saccades1'
						onclick="uncheck('horizontal_oculomotor_slow_saccades', 1)"
						name="horizontal_oculomotor_slow_saccades"
						<?php if(isset($check_horizontal_oculomotor_slow_saccades_yes)){echo $check_horizontal_oculomotor_slow_saccades_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="horizontal_oculomotor_slow_saccades_temp" value='' />
					<td><input <?php echo $disabled_tous;?> type="text"
						style="width: 300px;"
						name="describe_horizontal_oculomotor_slow_saccades"
						value="<?php echo $hash_champ_valeur['describe_horizontal_oculomotor_slow_saccades']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Vertical slow saccades</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='vertical_oculomotor_slow_saccades0'
						onclick="uncheck('vertical_oculomotor_slow_saccades', 0)"
						name="vertical_oculomotor_slow_saccades"
						<?php if(isset($check_vertical_oculomotor_slow_saccades_no)){echo $check_vertical_oculomotor_slow_saccades_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='vertical_oculomotor_slow_saccades1'
						onclick="uncheck('vertical_oculomotor_slow_saccades', 1)"
						name="vertical_oculomotor_slow_saccades"
						<?php if(isset($check_vertical_oculomotor_slow_saccades_yes)){echo $check_vertical_oculomotor_slow_saccades_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="vertical_oculomotor_slow_saccades_temp" value='' />
					<td><input <?php echo $disabled_tous;?> type="text"
						style="width: 300px;"
						name="describe_vertical_oculomotor_slow_saccades"
						value="<?php echo $hash_champ_valeur['describe_vertical_oculomotor_slow_saccades']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Ocular motor apraxia</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='oculomotor_motor_apraxia0'
						onclick="uncheck('oculomotor_motor_apraxia', 0)"
						name="oculomotor_motor_apraxia"
						<?php if(isset($check_oculomotor_motor_apraxia_no)){echo $check_oculomotor_motor_apraxia_no ;}?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='oculomotor_motor_apraxia1'
						onclick="uncheck('oculomotor_motor_apraxia', 1)"
						name="oculomotor_motor_apraxia"
						<?php if(isset($check_oculomotor_motor_apraxia_yes)){echo $check_oculomotor_motor_apraxia_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="oculomotor_motor_apraxia_temp" value='' />
					<td><input <?php echo $disabled_tous;?> type="text"
						style="width: 300px;" name="describe_oculomotor_motor_apraxia"
						value="<?php echo $hash_champ_valeur['describe_oculomotor_motor_apraxia']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Vertical ophtalmoplegia</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='oculomotor_vertical_ophtalmoplegia0'
						onclick="uncheck('oculomotor_vertical_ophtalmoplegia', 0)"
						name="oculomotor_vertical_ophtalmoplegia"
						<?php if(isset($check_oculomotor_vertical_ophtalmoplegia_no)){echo $check_oculomotor_vertical_ophtalmoplegia_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='oculomotor_vertical_ophtalmoplegia1'
						onclick="uncheck('oculomotor_vertical_ophtalmoplegia', 1)"
						name="oculomotor_vertical_ophtalmoplegia"
						<?php if(isset($check_oculomotor_vertical_ophtalmoplegia_yes)){echo $check_oculomotor_vertical_ophtalmoplegia_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="oculomotor_vertical_ophtalmoplegia_temp" value='' />
					<td><input <?php echo $disabled_tous;?> type="text"
						style="width: 300px;"
						name="describe_oculomotor_vertical_ophtalmoplegia"
						value="<?php echo $hash_champ_valeur['describe_oculomotor_vertical_ophtalmoplegia']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Horizontal ophtalmoplegia</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='oculomotor_horizontal_ophtalmoplegia0'
						onclick="uncheck('oculomotor_horizontal_ophtalmoplegia', 0)"
						name="oculomotor_horizontal_ophtalmoplegia"
						<?php if(isset($check_oculomotor_horizontal_ophtalmoplegia_no)){echo $check_oculomotor_horizontal_ophtalmoplegia_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='oculomotor_horizontal_ophtalmoplegia1'
						onclick="uncheck('oculomotor_horizontal_ophtalmoplegia', 1)"
						name="oculomotor_horizontal_ophtalmoplegia"
						<?php if(isset($check_oculomotor_horizontal_ophtalmoplegia_yes)){echo $check_oculomotor_horizontal_ophtalmoplegia_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="oculomotor_horizontal_ophtalmoplegia_temp" value='' />
					<td><input <?php echo $disabled_tous;?> type="text"
						style="width: 300px;"
						name="describe_oculomotor_horizontal_ophtalmoplegia"
						value="<?php echo $hash_champ_valeur['describe_oculomotor_horizontal_ophtalmoplegia']; ?>" /></td>
				</tr>
			</table>
		</td>

	</tr>

	<tr>
		<td>
			<table class="secondaire">
				<tr>
					<td colspan="4"><p style="">
							<b> 11. Mental status </b>
						</p></td>
				</tr>
				<tr>
					<td></td>
					<td><b> No </b></td>
					<td><b> Yes </b></td>
					<td><b> At age </b></td>
					<td><b> Type </b></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Intellectual deterioration</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='intellectual_deterioration0'
						onclick="uncheck('intellectual_deterioration', 0)"
						name="intellectual_deterioration"
						<?php if(isset($check_intellectual_deterioration_no)){echo $check_intellectual_deterioration_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='intellectual_deterioration1'
						onclick="uncheck('intellectual_deterioration', 1)"
						name="intellectual_deterioration"
						<?php if(isset($check_intellectual_deterioration_yes)){echo $check_intellectual_deterioration_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="intellectual_deterioration_temp" value='' />
					<td class='lisible'><input <?php echo $disabled_tous;?> type="text"
						style="width: 100px;" name="intellectual_deterioration_age"
						value="<?php echo $hash_champ_valeur['intellectual_deterioration_age']; ?>"
						onBlur="onBlurNombre(this);" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?> type="text"
						style="width: 100px;" name="intellectual_deterioration_type"
						value="<?php echo $hash_champ_valeur['intellectual_deterioration_type']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Mental retardation</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='mental_retardation0'
						onclick="uncheck('mental_retardation', 0)"
						name="mental_retardation"
						<?php if(isset($check_mental_retardation_no)){echo $check_mental_retardation_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='mental_retardation1'
						onclick="uncheck('mental_retardation', 1)"
						name="mental_retardation"
						<?php if(isset($check_mental_retardation_yes)){echo $check_mental_retardation_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="mental_retardation_temp" value='' />
					<td class='lisible'><input <?php echo $disabled_tous;?> type="text"
						style="width: 100px;" name="mental_retardation_age"
						value="<?php echo $hash_champ_valeur['mental_retardation_age']; ?>"
						onBlur="onBlurNombre(this);" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?> type="text"
						style="width: 100px;" name="mental_retardation_type"
						value="<?php echo $hash_champ_valeur['mental_retardation_type']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Psychiatric symptoms</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='psychiatric_symptoms0'
						onclick="uncheck('psychiatric_symptoms', 0)"
						name="psychiatric_symptoms"
						<?php if(isset($check_psychiatric_symptoms_no)){echo $check_psychiatric_symptoms_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='psychiatric_symptoms1'
						onclick="uncheck('psychiatric_symptoms', 1)"
						name="psychiatric_symptoms"
						<?php if(isset($check_psychiatric_symptoms_yes)){echo $check_psychiatric_symptoms_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="psychiatric_symptoms_temp" value='' />
					<td>Describe : <input <?php echo $disabled_tous;?> type="text"
						style="width: 200px;" name="describe_psychiatric_symptoms"
						value="<?php echo $hash_champ_valeur['describe_psychiatric_symptoms']; ?>" /></td>
				</tr>
			</table>
		</td>

		<td>
			<table class="secondaire">
				<tr>
					<td colspan="4"><p style="">
							<b> 12. Other signs </b>
						</p></td>
				</tr>
				<tr>
					<td></td>
					<td><b> None </b></td>
					<td><b> Mild </b></td>
					<td><b> Moderate </b></td>
					<td><b> Severe </b></td>
					<td><b>Age</b></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Dysphagia</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='dysphagia0' onclick="uncheck('dysphagia', 0)"
						name="dysphagia"
						<?php if(isset($check_dysphagia_none)){echo $check_dysphagia_none ;}?>
						value="none" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='dysphagia1' onclick="uncheck('dysphagia', 1)"
						name="dysphagia"
						<?php if(isset($check_dysphagia_mild)){echo $check_dysphagia_mild;} ?>
						value="mild" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='dysphagia2' onclick="uncheck('dysphagia', 2)"
						name="dysphagia"
						<?php if(isset($check_dysphagia_moderate)){echo $check_dysphagia_moderate;} ?>
						value="moderate" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='dysphagia3' onclick="uncheck('dysphagia', 3)"
						name="dysphagia"
						<?php if(isset($check_dysphagia_severe)){echo $check_dysphagia_severe;} ?>
						value="severe" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="dysphagia_temp" value='' />
					<td class='lisible'><input <?php echo $disabled_tous;?> type="text"
						style="width: 100px;" name="age_dysphagia"
						value="<?php echo $hash_champ_valeur['age_dysphagia']; ?>"
						onBlur="onBlurNombre(this);" /></td>

					<!--
		<td class='lisible'><input <?php echo $disabled_tous;?> type="text" style="width:100px;" name="describe_dysphagia" value="<?php echo $hash_champ_valeur['describe_dysphagia']; ?>" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="text" style="width:100px;" name="dysphagia_severity" value="<?php echo $hash_champ_valeur['dysphagia_severity']; ?>" /></td>
		-->
				</tr>
				<tr>
					<td></td>
					<td><b><br /> No </td>
					<td><b> Yes </b></td>
					<td><b> Describe </b></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Skin problems</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='skin_problems0'
						onclick="uncheck('skin_problems', 0)" name="skin_problems"
						<?php if(isset($check_skin_problems_no)){echo $check_skin_problems_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='skin_problems1'
						onclick="uncheck('skin_problems', 1)" name="skin_problems"
						<?php if(isset($check_skin_problems_yes)){echo $check_skin_problems_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="skin_problems_temp" value='' />
					<td colspan=3><input <?php echo $disabled_tous;?> type="text"
						style="width: 100px;" name="describe_skin_problems"
						value="<?php echo $hash_champ_valeur['describe_skin_problems']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Hearing impairment</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='hearing_impairment0'
						onclick="uncheck('hearing_impairment', 0)"
						name="hearing_impairment"
						<?php if(isset($check_hearing_impairment_no)){echo $check_hearing_impairment_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='hearing_impairment1'
						onclick="uncheck('hearing_impairment', 1)"
						name="hearing_impairment"
						<?php if(isset($check_hearing_impairment_yes)){echo $check_hearing_impairment_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="hearing_impairment_temp" value='' />
					<td colspan=3><input <?php echo $disabled_tous;?> type="text"
						style="width: 100px;" name="describe_hearing_impairment"
						value="<?php echo $hash_champ_valeur['describe_hearing_impairment']; ?>" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td class='lisible'>Epilepsy</td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='epilepsy0' onclick="uncheck('epilepsy', 0)"
						name="epilepsy"
						<?php if(isset($check_epilepsy_no)){echo $check_epilepsy_no;} ?>
						value="no" /></td>
					<td class='lisible'><input <?php echo $disabled_tous;?>
						type="radio" id='epilepsy1' onclick="uncheck('epilepsy', 1)"
						name="epilepsy"
						<?php if(isset($check_epilepsy_yes)){echo $check_epilepsy_yes;} ?>
						value="yes" /></td>
					<input <?php echo $disabled_tous;?> type="hidden"
						id="epilepsy_temp" value='' />
					<td colspan=3>At age : <input <?php echo $disabled_tous;?>
						type="text" style="width: 100px;" name="epilepsy_age"
						value="<?php echo $hash_champ_valeur['epilepsy_age']; ?>"
						onBlur="onBlurNombre(this);" /> Type : <input
						<?php echo $disabled_tous;?> type="text" style="width: 100px;"
						name="epilepsy_type"
						value="<?php echo $hash_champ_valeur['epilepsy_type']; ?>" /></td>
				</tr>

			</table>
		</td>

	</tr>

	<tr>
		<td>
			<table class="secondaire">
				<tr>
					<td colspan="10"><p style="">
							<b> 13: Other medical complaints: </b>
						</p> <textarea cols="60" rows="4" name="other_medical_complaints"><?php echo $hash_champ_valeur['other_medical_complaints']; ?></textarea></td>
				</tr>

			</table>
		</td>
	</tr>

	<tr>
		<td>
			<table>
				<tr>
					<td>
					
					<td><input <?php echo $disabled_tous.' ';?> type='submit'
						name='submitprinc' value='Save' value='Save' /></td>
					</td>
				</tr>
			</table>
		</td>
	</tr>
</table>

<!------------------------------------->

<div id="annexes">
	<table class='principale'>

		<tr>
			<td colspan="4"><p style="">
					<b>G. FUNCTIONAL CLINICAL EVALUATION - Please perform ALL tests </b>
				</p></td>
		</tr>

		<!--<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'"><td><a href="./sprs.php?form=<?php echo $_SESSION['form']; ?>"> SPRS (annex 1) : </a></td><td><input <?php echo $disabled_tous;?> type="text" name="score_SPRS" size="5" value="<?php echo $hash_champ_valeur['score_SPRS']; ?>" />/52</td></tr>-->
		<tr onMouseOver="this.className='highlight'"
			onMouseOut="this.className='normal'">
			<td><a href="./sara.php?form=<?php echo $_SESSION['form']; ?>"> SARA
					(Scale for the Assessment and Rating of Ataxia) : </a></td>
			<td><input <?php echo $disabled_tous;?> type="text" name="score_SARA"
				size="5" value="<?php echo $hash_champ_valeur['score_SARA']; ?>" />/40</td>
		</tr>
		<tr onMouseOver="this.className='highlight'"
			onMouseOut="this.className='normal'">
			<td><a href="./ccfs.php?form=<?php echo $_SESSION['form']; ?>"> CCFS
					(Composite Cerebellar Functional Severity Score) : </a></td>
			<td><input <?php echo $disabled_tous;?> type="text" name="score_CCFS"
				size="5" value="<?php echo $hash_champ_valeur['score_CCFS']; ?>" /></td>
			<!--<td> score OPYNOV <br /><input <?php echo $disabled_tous;?> type="text" name="score_OPYNOV" size="5" value="<?php echo $hash_champ_valeur['score_OPYNOV']; ?>" /></td>-->
			<td>Board number <br /> <input <?php echo $disabled_tous;?>
				type="text" name="board_number" size="10"
				value="<?php echo $hash_champ_valeur['board_number']; ?>" /></td>
			<td>Exam number <br /> <input <?php echo $disabled_tous;?>
				type="text" name="exam_number" size="10"
				value="<?php echo $hash_champ_valeur['exam_number']; ?>" /></td>
			<td>H(alf) score <br /> <input <?php echo $disabled_tous;?>
				type="text" name="half_score" size="5"
				value="<?php echo $hash_champ_valeur['half_score']; ?>" /><br />
				F(ull) Score (including writing) <br /> <input
				<?php echo $disabled_tous;?> type="text" name="full_score" size="5"
				value="<?php echo $hash_champ_valeur['full_score']; ?>" />
			</td>
		</tr>
		<!--<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'"><td><a href="./25fat.php?form=<?php echo $_SESSION['form']; ?>"> 25 feet ambulatory test (annex 4) : </a></td><td><input <?php echo $disabled_tous;?> type="text" name="score_25FAT" size="5" value="<?php echo $hash_champ_valeur['score_25FAT']; ?>" />sec</td></tr>-->
		<tr onMouseOver="this.className='highlight'"
			onMouseOut="this.className='normal'">
			<td><a href="./uhdrs.php?form=<?php echo $_SESSION['form']; ?>">
					UHDRS (Unified Huntington's Disease Rating Scale) : </a></td>
			<td><input <?php echo $disabled_tous;?> type="text"
				name="score_UHDRS" size="5"
				value="<?php echo $hash_champ_valeur['score_UHDRS']; ?>" />/25</td>
		</tr>
		<!--<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'"><td><a href="./ambus.php?form=<?php echo $_SESSION['form']; ?>"> AMBUS (annex 6) : </a></td><td><input <?php echo $disabled_tous;?> type="text" name="score_AMBUS" size="5" value="<?php echo $hash_champ_valeur['score_AMBUS']; ?>" /></td></tr>-->
	</table>
</div>

<!------------------------------------->

<table class='principale'>
	<tr>
		<td colspan="4"><p style="">
				<b>D. PREDOMINANT SIGNS at examination</b>
			</p></td>
	</tr>

	<tr>
		<td></td>
		<td colspan="4"><b> SPASTICITY </b></td>
		<td></td>
		<td colspan="4"><b> CEREBELLAR ATAXIA </b></td>
	</tr>
	<tr>
		<td></td>
		<td><b> None </b></td>
		<td><b> Mild </b></td>
		<td><b> Moder. </b></td>
		<td><b> Severe </b></td>
		<td></td>
		<td><b> None </b></td>
		<td><b> Mild </b></td>
		<td><b> Moder. </b></td>
		<td><b> Severe </b></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Upper limbs</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_upper_limbs0'
			onclick="uncheck('spasticity_upper_limbs', 0)"
			name="spasticity_upper_limbs"
			<?php if(isset($check_spasticity_upper_limbs_none)){echo $check_spasticity_upper_limbs_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_upper_limbs1'
			onclick="uncheck('spasticity_upper_limbs', 1)"
			name="spasticity_upper_limbs"
			<?php if(isset($check_spasticity_upper_limbs_mild)){echo $check_spasticity_upper_limbs_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_upper_limbs2'
			onclick="uncheck('spasticity_upper_limbs', 2)"
			name="spasticity_upper_limbs"
			<?php if(isset($check_spasticity_upper_limbs_moderate)){echo $check_spasticity_upper_limbs_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_upper_limbs3'
			onclick="uncheck('spasticity_upper_limbs', 3)"
			name="spasticity_upper_limbs"
			<?php if(isset($check_spasticity_upper_limbs_severe)){echo $check_spasticity_upper_limbs_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="spasticity_upper_limbs_temp" value='' />
		<td></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_upper_limbs0' onclick="uncheck('ataxia_upper_limbs', 0)"
			name="ataxia_upper_limbs"
			<?php if(isset($check_ataxia_upper_limbs_none)){echo $check_ataxia_upper_limbs_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_upper_limbs1' onclick="uncheck('ataxia_upper_limbs', 1)"
			name="ataxia_upper_limbs"
			<?php if(isset($check_ataxia_upper_limbs_mild)){echo $check_ataxia_upper_limbs_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_upper_limbs2' onclick="uncheck('ataxia_upper_limbs', 2)"
			name="ataxia_upper_limbs"
			<?php if(isset($check_ataxia_upper_limbs_moderate)){echo $check_ataxia_upper_limbs_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_upper_limbs3' onclick="uncheck('ataxia_upper_limbs', 3)"
			name="ataxia_upper_limbs"
			<?php if(isset($check_ataxia_upper_limbs_severe)){echo $check_ataxia_upper_limbs_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="ataxia_upper_limbs_temp" value='' />
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Lower limbs*</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_lower_limbs0'
			onclick="uncheck('spasticity_lower_limbs', 0)"
			name="spasticity_lower_limbs"
			<?php if(isset($check_spasticity_lower_limbs_none)){echo $check_spasticity_lower_limbs_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_lower_limbs1'
			onclick="uncheck('spasticity_lower_limbs', 1)"
			name="spasticity_lower_limbs"
			<?php if(isset($check_spasticity_lower_limbs_mild)){echo $check_spasticity_lower_limbs_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_lower_limbs2'
			onclick="uncheck('spasticity_lower_limbs', 2)"
			name="spasticity_lower_limbs"
			<?php if(isset($check_spasticity_lower_limbs_moderate)){echo $check_spasticity_lower_limbs_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_lower_limbs3'
			onclick="uncheck('spasticity_lower_limbs', 3)"
			name="spasticity_lower_limbs"
			<?php if(isset($check_spasticity_lower_limbs_severe)){echo $check_spasticity_lower_limbs_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="spasticity_lower_limbs_temp" value='' />
		<td></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_lower_limbs0' onclick="uncheck('ataxia_lower_limbs', 0)"
			name="ataxia_lower_limbs"
			<?php if(isset($check_ataxia_lower_limbs_none)){echo $check_ataxia_lower_limbs_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_lower_limbs1' onclick="uncheck('ataxia_lower_limbs', 1)"
			name="ataxia_lower_limbs"
			<?php if(isset($check_ataxia_lower_limbs_mild)){echo $check_ataxia_lower_limbs_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_lower_limbs2' onclick="uncheck('ataxia_lower_limbs', 2)"
			name="ataxia_lower_limbs"
			<?php if(isset($check_ataxia_lower_limbs_moderate)){echo $check_ataxia_lower_limbs_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_lower_limbs3' onclick="uncheck('ataxia_lower_limbs', 3)"
			name="ataxia_lower_limbs"
			<?php if(isset($check_ataxia_lower_limbs_severe)){echo $check_ataxia_lower_limbs_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="ataxia_lower_limbs_temp" value='' />
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Gait</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_gait0' onclick="uncheck('spasticity_gait', 0)"
			name="spasticity_gait"
			<?php if(isset($check_spasticity_gait_none)){echo $check_spasticity_gait_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_gait1' onclick="uncheck('spasticity_gait', 1)"
			name="spasticity_gait"
			<?php if(isset($check_spasticity_gait_mild)){echo $check_spasticity_gait_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_gait2' onclick="uncheck('spasticity_gait', 2)"
			name="spasticity_gait"
			<?php if(isset($check_spasticity_gait_moderate)){echo $check_spasticity_gait_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_gait3' onclick="uncheck('spasticity_gait', 3)"
			name="spasticity_gait"
			<?php if(isset($check_spasticity_gait_severe)){echo $check_spasticity_gait_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="spasticity_gait_temp" value='' />
		<td></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_gait0' onclick="uncheck('ataxia_gait', 0)"
			name="ataxia_gait"
			<?php if(isset($check_ataxia_gait_none)){echo $check_ataxia_gait_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_gait1' onclick="uncheck('ataxia_gait', 1)"
			name="ataxia_gait"
			<?php if(isset($check_ataxia_gait_mild)){echo $check_ataxia_gait_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_gait2' onclick="uncheck('ataxia_gait', 2)"
			name="ataxia_gait"
			<?php if(isset($check_ataxia_gait_moderate)){echo $check_ataxia_gait_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_gait3' onclick="uncheck('ataxia_gait', 3)"
			name="ataxia_gait"
			<?php if(isset($check_ataxia_gait_severe)){echo $check_ataxia_gait_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="ataxia_gait_temp" value='' />
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td class='lisible'>Dysarthria</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_dysarthria0'
			onclick="uncheck('spasticity_dysarthria', 0)"
			name="spasticity_dysarthria"
			<?php if(isset($check_spasticity_dysarthria_none)){echo $check_spasticity_dysarthria_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_dysarthria1'
			onclick="uncheck('spasticity_dysarthria', 1)"
			name="spasticity_dysarthria"
			<?php if(isset($check_spasticity_dysarthria_mild)){echo $check_spasticity_dysarthria_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_dysarthria2'
			onclick="uncheck('spasticity_dysarthria', 2)"
			name="spasticity_dysarthria"
			<?php if(isset($check_spasticity_dysarthria_moderate)){echo $check_spasticity_dysarthria_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='spasticity_dysarthria3'
			onclick="uncheck('spasticity_dysarthria', 3)"
			name="spasticity_dysarthria"
			<?php if(isset($check_spasticity_dysarthria_severe)){echo $check_spasticity_dysarthria_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="spasticity_dysarthria_temp" value='' />
		<td></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_dysarthria0' onclick="uncheck('ataxia_dysarthria', 0)"
			name="ataxia_dysarthria"
			<?php if(isset($check_ataxia_dysarthria_none)){echo $check_ataxia_dysarthria_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_dysarthria1' onclick="uncheck('ataxia_dysarthria', 1)"
			name="ataxia_dysarthria"
			<?php if(isset($check_ataxia_dysarthria_mild)){echo $check_ataxia_dysarthria_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_dysarthria2' onclick="uncheck('ataxia_dysarthria', 2)"
			name="ataxia_dysarthria"
			<?php if(isset($check_ataxia_dysarthria_moderate)){echo $check_ataxia_dysarthria_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='ataxia_dysarthria3' onclick="uncheck('ataxia_dysarthria', 3)"
			name="ataxia_dysarthria"
			<?php if(isset($check_ataxia_dysarthria_severe)){echo $check_ataxia_dysarthria_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="ataxia_dysarthria_temp" value='' />
	</tr>
	<tr>
		<td colspan="8">* at rest for spasticity and knee-heel for ataxia</td>
	</tr>
</table>





<table class='principale'>
	<tr>
		<td colspan="4"><p style="">
				<b>J. COMPLEMENTARY INVESTIGATIONS </b>
			</p></td>
	</tr>
	<tr>
		<td><b>Examination</b></td>
		<td><b>Not done</b></td>
		<td><b>Normal</b></td>
		<td><b>Abnormal</b></td>
		<td></td>
		<td>None</td>
		<td>Mild</td>
		<td>Moderate</td>
		<td>Severe</td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>Cerebral MRI</b></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri0' onclick="uncheck('cerebral_mri', 0)"
			name="cerebral_mri"
			<?php if(isset($check_cerebral_mri_not_done)){echo $check_cerebral_mri_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri1' onclick="uncheck('cerebral_mri', 1)"
			name="cerebral_mri"
			<?php if(isset($check_cerebral_mri_normal)){echo $check_cerebral_mri_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri2' onclick="uncheck('cerebral_mri', 2)"
			name="cerebral_mri"
			<?php if(isset($check_cerebral_mri_abnormal)){echo $check_cerebral_mri_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="cerebral_mri_temp" value='' />
		<td><b>Atrophy</b></td>
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
		<td></td>
		<td></td>
		<td></td>
		<td class='lisible'>Cerebrum :</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_cerebrum_specify0'
			onclick="uncheck('cerebral_mri_cerebrum_specify', 0)"
			name="cerebral_mri_cerebrum_specify"
			<?php if(isset($check_cerebral_mri_cerebrum_specify_none)){echo $check_cerebral_mri_cerebrum_specify_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_cerebrum_specify1'
			onclick="uncheck('cerebral_mri_cerebrum_specify', 1)"
			name="cerebral_mri_cerebrum_specify"
			<?php if(isset($check_cerebral_mri_cerebrum_specify_mild)){echo $check_cerebral_mri_cerebrum_specify_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_cerebrum_specify2'
			onclick="uncheck('cerebral_mri_cerebrum_specify', 2)"
			name="cerebral_mri_cerebrum_specify"
			<?php if(isset($check_cerebral_mri_cerebrum_specify_moderate)){echo $check_cerebral_mri_cerebrum_specify_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_cerebrum_specify3'
			onclick="uncheck('cerebral_mri_cerebrum_specify', 3)"
			name="cerebral_mri_cerebrum_specify"
			<?php if(isset($check_cerebral_mri_cerebrum_specify_severe)){echo $check_cerebral_mri_cerebrum_specify_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="cerebral_mri_cerebrum_specify_temp" value='' />
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
		<td></td>
		<td></td>
		<td></td>
		<td class='lisible'>Cerebellum :</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_cerebellum_specify0'
			onclick="uncheck('cerebral_mri_cerebellum_specify', 0)"
			name="cerebral_mri_cerebellum_specify"
			<?php if(isset($check_cerebral_mri_cerebellum_specify_none)){echo $check_cerebral_mri_cerebellum_specify_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_cerebellum_specify1'
			onclick="uncheck('cerebral_mri_cerebellum_specify', 1)"
			name="cerebral_mri_cerebellum_specify"
			<?php if(isset($check_cerebral_mri_cerebellum_specify_mild)){echo $check_cerebral_mri_cerebellum_specify_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_cerebellum_specify2'
			onclick="uncheck('cerebral_mri_cerebellum_specify', 2)"
			name="cerebral_mri_cerebellum_specify"
			<?php if(isset($check_cerebral_mri_cerebellum_specify_moderate)){echo $check_cerebral_mri_cerebellum_specify_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_cerebellum_specify3'
			onclick="uncheck('cerebral_mri_cerebellum_specify', 3)"
			name="cerebral_mri_cerebellum_specify"
			<?php if(isset($check_cerebral_mri_cerebellum_specify_severe)){echo $check_cerebral_mri_cerebellum_specify_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="cerebral_mri_cerebellum_specify_temp" value='' />
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
		<td></td>
		<td></td>
		<td></td>
		<td class='lisible'>Brainstem :</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_brainstem_specify0'
			onclick="uncheck('cerebral_mri_brainstem_specify', 0)"
			name="cerebral_mri_brainstem_specify"
			<?php if(isset($check_cerebral_mri_brainstem_specify_none)){echo $check_cerebral_mri_brainstem_specify_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_brainstem_specify1'
			onclick="uncheck('cerebral_mri_brainstem_specify', 1)"
			name="cerebral_mri_brainstem_specify"
			<?php if(isset($check_cerebral_mri_brainstem_specify_mild)){echo $check_cerebral_mri_brainstem_specify_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_brainstem_specify2'
			onclick="uncheck('cerebral_mri_brainstem_specify', 2)"
			name="cerebral_mri_brainstem_specify"
			<?php if(isset($check_cerebral_mri_brainstem_specify_moderate)){echo $check_cerebral_mri_brainstem_specify_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_brainstem_specify3'
			onclick="uncheck('cerebral_mri_brainstem_specify', 3)"
			name="cerebral_mri_brainstem_specify"
			<?php if(isset($check_cerebral_mri_brainstem_specify_severe)){echo $check_cerebral_mri_brainstem_specify_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="cerebral_mri_brainstem_specify_temp" value='' />
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
		<td></td>
		<td></td>
		<td></td>
		<td class='lisible'>Corpus callosum :</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_corpus_callosum_specify0'
			onclick="uncheck('cerebral_mri_corpus_callosum_specify', 0)"
			name="cerebral_mri_corpus_callosum_specify"
			<?php if(isset($check_cerebral_mri_corpus_callosum_specify_none)){echo $check_cerebral_mri_corpus_callosum_specify_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_corpus_callosum_specify1'
			onclick="uncheck('cerebral_mri_corpus_callosum_specify', 1)"
			name="cerebral_mri_corpus_callosum_specify"
			<?php if(isset($check_cerebral_mri_corpus_callosum_specify_mild)){echo $check_cerebral_mri_corpus_callosum_specify_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_corpus_callosum_specify2'
			onclick="uncheck('cerebral_mri_corpus_callosum_specify', 2)"
			name="cerebral_mri_corpus_callosum_specify"
			<?php if(isset($check_cerebral_mri_corpus_callosum_specify_moderate)){echo $check_cerebral_mri_corpus_callosum_specify_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_corpus_callosum_specify3'
			onclick="uncheck('cerebral_mri_corpus_callosum_specify', 3)"
			name="cerebral_mri_corpus_callosum_specify"
			<?php if(isset($check_cerebral_mri_corpus_callosum_specify_severe)){echo $check_cerebral_mri_corpus_callosum_specify_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="cerebral_mri_corpus_callosum_specify_temp" value='' />
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
		<td></td>
		<td></td>
		<td></td>
		<td class='lisible'>Upper spinal cord atrophy :</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_upper_spinal_cord_specify0'
			onclick="uncheck('cerebral_mri_upper_spinal_cord_specify', 0)"
			name="cerebral_mri_upper_spinal_cord_specify"
			<?php if(isset($check_cerebral_mri_upper_spinal_cord_specify_none)){echo $check_cerebral_mri_upper_spinal_cord_specify_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_upper_spinal_cord_specify1'
			onclick="uncheck('cerebral_mri_upper_spinal_cord_specify', 1)"
			name="cerebral_mri_upper_spinal_cord_specify"
			<?php if(isset($check_cerebral_mri_upper_spinal_cord_specify_mild)){echo $check_cerebral_mri_upper_spinal_cord_specify_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_upper_spinal_cord_specify2'
			onclick="uncheck('cerebral_mri_upper_spinal_cord_specify', 2)"
			name="cerebral_mri_upper_spinal_cord_specify"
			<?php if(isset($check_cerebral_mri_upper_spinal_cord_specify_moderate)){echo $check_cerebral_mri_upper_spinal_cord_specify_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='cerebral_mri_upper_spinal_cord_specify3'
			onclick="uncheck('cerebral_mri_upper_spinal_cord_specify', 3)"
			name="cerebral_mri_upper_spinal_cord_specify"
			<?php if(isset($check_cerebral_mri_upper_spinal_cord_specify_severe)){echo $check_cerebral_mri_upper_spinal_cord_specify_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="cerebral_mri_upper_spinal_cord_specify_temp" value='' />
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
		<td></td>
		<td></td>
		<td></td>
		<td><br /> <b>White matter changes</b></td>
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
		<td></td>
		<td></td>
		<td></td>
		<td class='lisible'>Cerebrum :</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_cerebrum_specify0'
			onclick="uncheck('white_matter_mri_cerebrum_specify', 0)"
			name="white_matter_mri_cerebrum_specify"
			<?php if(isset($check_white_matter_mri_cerebrum_specify_none)){echo $check_white_matter_mri_cerebrum_specify_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_cerebrum_specify1'
			onclick="uncheck('white_matter_mri_cerebrum_specify', 1)"
			name="white_matter_mri_cerebrum_specify"
			<?php if(isset($check_white_matter_mri_cerebrum_specify_mild)){echo $check_white_matter_mri_cerebrum_specify_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_cerebrum_specify2'
			onclick="uncheck('white_matter_mri_cerebrum_specify', 2)"
			name="white_matter_mri_cerebrum_specify"
			<?php if(isset($check_white_matter_mri_cerebrum_specify_moderate)){echo $check_white_matter_mri_cerebrum_specify_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_cerebrum_specify3'
			onclick="uncheck('white_matter_mri_cerebrum_specify', 3)"
			name="white_matter_mri_cerebrum_specify"
			<?php if(isset($check_white_matter_mri_cerebrum_specify_severe)){echo $check_white_matter_mri_cerebrum_specify_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="white_matter_mri_cerebrum_specify_temp" value='' />
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
		<td></td>
		<td></td>
		<td></td>
		<td class='lisible'>Cerebellum :</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_cerebellum_specify0'
			onclick="uncheck('white_matter_mri_cerebellum_specify', 0)"
			name="white_matter_mri_cerebellum_specify"
			<?php if(isset($check_white_matter_mri_cerebellum_specify_none)){echo $check_white_matter_mri_cerebellum_specify_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_cerebellum_specify1'
			onclick="uncheck('white_matter_mri_cerebellum_specify', 1)"
			name="white_matter_mri_cerebellum_specify"
			<?php if(isset($check_white_matter_mri_cerebellum_specify_mild)){echo $check_white_matter_mri_cerebellum_specify_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_cerebellum_specify2'
			onclick="uncheck('white_matter_mri_cerebellum_specify', 2)"
			name="white_matter_mri_cerebellum_specify"
			<?php if(isset($check_white_matter_mri_cerebellum_specify_moderate)){echo $check_white_matter_mri_cerebellum_specify_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_cerebellum_specify3'
			onclick="uncheck('white_matter_mri_cerebellum_specify', 3)"
			name="white_matter_mri_cerebellum_specify"
			<?php if(isset($check_white_matter_mri_cerebellum_specify_severe)){echo $check_white_matter_mri_cerebellum_specify_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="white_matter_mri_cerebellum_specify_temp" value='' />
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
		<td></td>
		<td></td>
		<td></td>
		<td class='lisible'>Brainstem :</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_brainstem_specify0'
			onclick="uncheck('white_matter_mri_brainstem_specify', 0)"
			name="white_matter_mri_brainstem_specify"
			<?php if(isset($check_white_matter_mri_brainstem_specify_none)){echo $check_white_matter_mri_brainstem_specify_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_brainstem_specify1'
			onclick="uncheck('white_matter_mri_brainstem_specify', 1)"
			name="white_matter_mri_brainstem_specify"
			<?php if(isset($check_white_matter_mri_brainstem_specify_mild)){echo $check_white_matter_mri_brainstem_specify_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_brainstem_specify2'
			onclick="uncheck('white_matter_mri_brainstem_specify', 2)"
			name="white_matter_mri_brainstem_specify"
			<?php if(isset($check_white_matter_mri_brainstem_specify_moderate)){echo $check_white_matter_mri_brainstem_specify_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_brainstem_specify3'
			onclick="uncheck('white_matter_mri_brainstem_specify', 3)"
			name="white_matter_mri_brainstem_specify"
			<?php if(isset($check_white_matter_mri_brainstem_specify_severe)){echo $check_white_matter_mri_brainstem_specify_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="white_matter_mri_brainstem_specify_temp" value='' />
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
		<td></td>
		<td></td>
		<td></td>
		<td class='lisible'>Corpus callosum :</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_corpus_callosum_specify0'
			onclick="uncheck('white_matter_mri_corpus_callosum_specify', 0)"
			name="white_matter_mri_corpus_callosum_specify"
			<?php if(isset($check_white_matter_mri_corpus_callosum_specify_none)){echo $check_white_matter_mri_corpus_callosum_specify_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_corpus_callosum_specify1'
			onclick="uncheck('white_matter_mri_corpus_callosum_specify', 1)"
			name="white_matter_mri_corpus_callosum_specify"
			<?php if(isset($check_white_matter_mri_corpus_callosum_specify_mild)){echo $check_white_matter_mri_corpus_callosum_specify_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_corpus_callosum_specify2'
			onclick="uncheck('white_matter_mri_corpus_callosum_specify', 2)"
			name="white_matter_mri_corpus_callosum_specify"
			<?php if(isset($check_white_matter_mri_corpus_callosum_specify_moderate)){echo $check_white_matter_mri_corpus_callosum_specify_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_corpus_callosum_specify3'
			onclick="uncheck('white_matter_mri_corpus_callosum_specify', 3)"
			name="white_matter_mri_corpus_callosum_specify"
			<?php if(isset($check_white_matter_mri_corpus_callosum_specify_severe)){echo $check_white_matter_mri_corpus_callosum_specify_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="white_matter_mri_corpus_callosum_specify_temp" value='' />
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
		<td></td>
		<td></td>
		<td></td>
		<td class='lisible'>Upper spinal cord atrophy :</td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_upper_spinal_cord_specify0'
			onclick="uncheck('white_matter_mri_upper_spinal_cord_specify', 0)"
			name="white_matter_mri_upper_spinal_cord_specify"
			<?php if(isset($check_white_matter_mri_upper_spinal_cord_specify_none)){echo $check_white_matter_mri_upper_spinal_cord_specify_none;} ?>
			value="none" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_upper_spinal_cord_specify1'
			onclick="uncheck('white_matter_mri_upper_spinal_cord_specify', 1)"
			name="white_matter_mri_upper_spinal_cord_specify"
			<?php if(isset($check_white_matter_mri_upper_spinal_cord_specify_mild)){echo $check_white_matter_mri_upper_spinal_cord_specify_mild;} ?>
			value="mild" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_upper_spinal_cord_specify2'
			onclick="uncheck('white_matter_mri_upper_spinal_cord_specify', 2)"
			name="white_matter_mri_upper_spinal_cord_specify"
			<?php if(isset($check_white_matter_mri_upper_spinal_cord_specify_moderate)){echo $check_white_matter_mri_upper_spinal_cord_specify_moderate;} ?>
			value="moderate" /></td>
		<td class='lisible'><input <?php echo $disabled_tous;?> type="radio"
			id='white_matter_mri_upper_spinal_cord_specify3'
			onclick="uncheck('white_matter_mri_upper_spinal_cord_specify', 3)"
			name="white_matter_mri_upper_spinal_cord_specify"
			<?php if(isset($check_white_matter_mri_upper_spinal_cord_specify_severe)){echo $check_white_matter_mri_upper_spinal_cord_specify_severe;} ?>
			value="severe" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="white_matter_mri_upper_spinal_cord_specify_temp" value='' />
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
		<td></td>
		<td></td>
		<td></td>
		<td><br /> <b>NBIA </b></td>
		<td><br /> <label><input <?php echo $disabled_tous;?> type="radio"
				id='nbia0' onclick="uncheck('nbia', 0)" name="nbia"
				<?php if(isset($check_nbia_yes)){echo $check_nbia_yes;} ?>
				value="yes" /> yes</label><br /> <label><input
				<?php echo $disabled_tous;?> type="radio" id='nbia1'
				onclick="uncheck('nbia', 1)" name="nbia"
				<?php if(isset($check_nbia_no)){echo $check_nbia_no;} ?> value="no" />
				no</label></td>
		<input <?php echo $disabled_tous;?> type="hidden" id="nbia_temp"
			value='' />
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td></td>
		<td></td>
		<td></td>
		<td></td>
		<td><b>Other</b></td>
		<td colspan=3><input <?php echo $disabled_tous;?> type="text"
			style="width: 300px;" name="cerebellar_mri_other"
			value="<?php echo $hash_champ_valeur['cerebellar_mri_other']; ?>" /></td>
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>Medullar MRI</b></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='medullar_mri0' onclick="uncheck('medullar_mri', 0)"
			name="medullar_mri"
			<?php if(isset($check_medullar_mri_not_done)){echo $check_medullar_mri_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='medullar_mri1' onclick="uncheck('medullar_mri', 1)"
			name="medullar_mri"
			<?php if(isset($check_medullar_mri_normal)){echo $check_medullar_mri_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='medullar_mri2' onclick="uncheck('medullar_mri', 2)"
			name="medullar_mri"
			<?php if(isset($check_medullar_mri_abnormal)){echo $check_medullar_mri_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="medullar_mri_temp" value='' />
	</tr>

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>Polyneuropathy</b></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='polyneuropathy0' onclick="uncheck('polyneuropathy', 0)"
			name="polyneuropathy"
			<?php if(isset($check_polyneuropathy_not_done)){echo $check_polyneuropathy_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='polyneuropathy1' onclick="uncheck('polyneuropathy', 1)"
			name="polyneuropathy"
			<?php if(isset($check_polyneuropathy_normal)){echo $check_polyneuropathy_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='polyneuropathy2' onclick="uncheck('polyneuropathy', 2)"
			name="polyneuropathy"
			<?php if(isset($check_polyneuropathy_abnormal)){echo $check_polyneuropathy_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="polyneuropathy_tmp" value='' />

		<td><select <?php echo $disabled_tous;?> name='polyneuropathy_specify'
			size='1'>
				<option></option>
				<option value='pure sensitive'
					<?php if(isset($hash_champ_valeur['polyneuropathy_specify']) and $hash_champ_valeur['polyneuropathy_specify'] == 'pure sensitive'){ echo "selected='selected'"; } ?>>
					pure sensitive</option>
				<option value='pure motor'
					<?php if(isset($hash_champ_valeur['polyneuropathy_specify']) and $hash_champ_valeur['polyneuropathy_specify'] == 'pure motor'){ echo "selected='selected'"; } ?>>
					pure motor</option>
				<option value='sensitive and motor'
					<?php if(isset($hash_champ_valeur['polyneuropathy_specify']) and $hash_champ_valeur['polyneuropathy_specify'] == 'sensitive and motor'){ echo "selected='selected'"; } ?>>
					sensitive and motor</option>
				<option value='axonal'
					<?php if(isset($hash_champ_valeur['polyneuropathy_specify']) and $hash_champ_valeur['polyneuropathy_specify'] == 'axonal'){ echo "selected='selected'"; } ?>>
					axonal</option>
				<option value='demyelinisant'
					<?php if(isset($hash_champ_valeur['polyneuropathy_specify']) and $hash_champ_valeur['polyneuropathy_specify'] == 'demyelinisant'){ echo "selected='selected'"; } ?>>
					demyelinisant</option>
		</select></td>

		<td>Other <input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="polyneuropathy_other"
			value="<?php echo $hash_champ_valeur['polyneuropathy_other']; ?>" /></td>
	</tr>


	<!--
		<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'">
			<td><b>3. EMG + NCV UL</b></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='emg_ncv_ul0' onclick="uncheck('emg_ncv_ul', 0)" name="emg_ncv_ul" <?php if(isset($check_emg_ncv_ul_not_done)){echo $check_emg_ncv_ul_not_done;} ?> value="not_done"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='emg_ncv_ul1' onclick="uncheck('emg_ncv_ul', 1)" name="emg_ncv_ul" <?php if(isset($check_emg_ncv_ul_normal)){echo $check_emg_ncv_ul_normal;} ?> value="normal"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='emg_ncv_ul2' onclick="uncheck('emg_ncv_ul', 2)" name="emg_ncv_ul" <?php if(isset($check_emg_ncv_ul_abnormal)){echo $check_emg_ncv_ul_abnormal;} ?> value="abnormal"/></td>
			<input <?php echo $disabled_tous;?> type="hidden" id="emg_ncv_ul_temp" value='' />
			<td><input <?php echo $disabled_tous;?> type="text" style="width:100px;" name="emg_ncv_ul_specify" value="<?php echo $hash_champ_valeur['emg_ncv_ul_specify']; ?>" /></td>
		</tr>
		<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'">
			<td><b>4. EMG + NCV LL</b></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='emg_ncv_ll0' onclick="uncheck('emg_ncv_ll', 0)" name="emg_ncv_ll" <?php if(isset($check_emg_ncv_ll_not_done)){echo $check_emg_ncv_ll_not_done;} ?> value="not_done"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='emg_ncv_ll1' onclick="uncheck('emg_ncv_ll', 1)" name="emg_ncv_ll" <?php if(isset($check_emg_ncv_ll_normal)){echo $check_emg_ncv_ll_normal;} ?> value="normal"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='emg_ncv_ll2' onclick="uncheck('emg_ncv_ll', 2)" name="emg_ncv_ll" <?php if(isset($check_emg_ncv_ll_abnormal)){echo $check_emg_ncv_ll_abnormal;} ?> value="abnormal"/></td>
			<input <?php echo $disabled_tous;?> type="hidden" id="emg_ncv_ll_temp" value='' />
			<td><input <?php echo $disabled_tous;?> type="text" style="width:100px;" name="emg_ncv_ll_specify" value="<?php echo $hash_champ_valeur['emg_ncv_ll_specify']; ?>" /></td>
		</tr>
		-->

	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>VEP</b></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='vep0'
			onclick="uncheck('vep', 0)" name="vep"
			<?php if(isset($check_vep_not_done)){echo $check_vep_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='vep1'
			onclick="uncheck('vep', 1)" name="vep"
			<?php if(isset($check_vep_normal)){echo $check_vep_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='vep2'
			onclick="uncheck('vep', 2)" name="vep"
			<?php if(isset($check_vep_abnormal)){echo $check_vep_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden" id="vep_temp"
			value='' />
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="vep_specify"
			value="<?php echo $hash_champ_valeur['vep_specify']; ?>" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>AEP</b></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='aep0'
			onclick="uncheck('aep', 0)" name="aep"
			<?php if(isset($check_aep_not_done)){echo $check_aep_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='aep1'
			onclick="uncheck('aep', 1)" name="aep"
			<?php if(isset($check_aep_normal)){echo $check_aep_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='aep2'
			onclick="uncheck('aep', 2)" name="aep"
			<?php if(isset($check_aep_abnormal)){echo $check_aep_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden" id="aep_temp"
			value='' />
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="aep_specify"
			value="<?php echo $hash_champ_valeur['aep_specify']; ?>" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>MEP</b></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='mep0'
			onclick="uncheck('mep', 0)" name="mep"
			<?php if(isset($check_mep_not_done)){echo $check_mep_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='mep1'
			onclick="uncheck('mep', 1)" name="mep"
			<?php if(isset($check_mep_normal)){echo $check_mep_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='mep2'
			onclick="uncheck('mep', 2)" name="mep"
			<?php if(isset($check_mep_abnormal)){echo $check_mep_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden" id="mep_temp"
			value='' />
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="mep_specify"
			value="<?php echo $hash_champ_valeur['mep_specify']; ?>" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>SEP</b></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='sep0'
			onclick="uncheck('sep', 0)" name="sep"
			<?php if(isset($check_sep_not_done)){echo $check_sep_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='sep1'
			onclick="uncheck('sep', 1)" name="sep"
			<?php if(isset($check_sep_normal)){echo $check_sep_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='sep2'
			onclick="uncheck('sep', 2)" name="sep"
			<?php if(isset($check_sep_abnormal)){echo $check_sep_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden" id="sep_temp"
			value='' />
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="sep_specify"
			value="<?php echo $hash_champ_valeur['sep_specify']; ?>" /></td>
	</tr>

	<tr>
		<td><br /> <br /> <b>BIOLOGY</b></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>&alpha;-foetoprotein</b></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='alphafoetoprotein0' onclick="uncheck('alphafoetoprotein', 0)"
			name="alphafoetoprotein"
			<?php if(isset($check_alphafoetoprotein_not_done)){echo $check_alphafoetoprotein_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='alphafoetoprotein1' onclick="uncheck('alphafoetoprotein', 1)"
			name="alphafoetoprotein"
			<?php if(isset($check_alphafoetoprotein_normal)){echo $check_alphafoetoprotein_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='alphafoetoprotein2' onclick="uncheck('alphafoetoprotein', 2)"
			name="alphafoetoprotein"
			<?php if(isset($check_alphafoetoprotein_abnormal)){echo $check_alphafoetoprotein_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="alphafoetoprotein_temp" value='' />
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="alphafoetoprotein_specify"
			value="<?php echo $hash_champ_valeur['alphafoetoprotein_specify']; ?>" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>Vitamin E</b></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='vitamin_E0'
			onclick="uncheck('vitamin_E', 0)" name="vitamin_E"
			<?php if(isset($check_vitamin_E_not_done)){echo $check_vitamin_E_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='vitamin_E1'
			onclick="uncheck('vitamin_E', 1)" name="vitamin_E"
			<?php if(isset($check_vitamin_E_normal)){echo $check_vitamin_E_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='vitamin_E2'
			onclick="uncheck('vitamin_E', 2)" name="vitamin_E"
			<?php if(isset($check_vitamin_E_abnormal)){echo $check_vitamin_E_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden" id="vitamin_E_temp"
			value='' />
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="vitamin_E_specify"
			value="<?php echo $hash_champ_valeur['vitamin_E_specify']; ?>" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>Albumin</b></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='albumin0'
			onclick="uncheck('albumin', 0)" name="albumin"
			<?php if(isset($check_albumin_not_done)){echo $check_albumin_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='albumin1'
			onclick="uncheck('albumin', 1)" name="albumin"
			<?php if(isset($check_albumin_normal)){echo $check_albumin_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='albumin2'
			onclick="uncheck('albumin', 2)" name="albumin"
			<?php if(isset($check_albumin_abnormal)){echo $check_albumin_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden" id="albumin_E_temp"
			value='' />
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="albumin_specify"
			value="<?php echo $hash_champ_valeur['albumin_specify']; ?>" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>Cholestanol</b></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='cholestanol0'
			onclick="uncheck('cholestanol', 0)" name="cholestanol"
			<?php if(isset($check_cholestanol_not_done)){echo $check_cholestanol_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='cholestanol1'
			onclick="uncheck('cholestanol', 1)" name="cholestanol"
			<?php if(isset($check_cholestanol_normal)){echo $check_cholestanol_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='cholestanoln2' onclick="uncheck('cholestanol', 2)"
			name="cholestanol"
			<?php if(isset($check_cholestanol_abnormal)){echo $check_cholestanol_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="cholestanol_temp" value='' />
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="cholestanol_specify"
			value="<?php echo $hash_champ_valeur['cholestanol_specify']; ?>" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>Total Cholesterol</b></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='cholesterol0'
			onclick="uncheck('cholesterol', 0)" name="cholesterol"
			<?php if(isset($check_cholesterol_not_done)){echo $check_cholesterol_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='cholesterol1'
			onclick="uncheck('cholesterol', 1)" name="cholesterol"
			<?php if(isset($check_cholesterol_normal)){echo $check_cholesterol_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='cholesterol2'
			onclick="uncheck('cholesterol', 2)" name="cholesterol"
			<?php if(isset($check_cholesterol_abnormal)){echo $check_cholesterol_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="cholesterol_temp" value='' />
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="cholesterol_specify"
			value="<?php echo $hash_champ_valeur['cholesterol_specify']; ?>" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>25-OH Cholesterol</b></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='_25OHcholesterol0' onclick="uncheck('_25OHcholesterol', 0)"
			name="_25OHcholesterol"
			<?php if(isset($check_25OHcholesterol_not_done)){echo $check_25OHcholesterol_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='_25OHcholesterol1' onclick="uncheck('_25OHcholesterol', 1)"
			name="_25OHcholesterol"
			<?php if(isset($check_25OHcholesterol_normal)){echo $check_25OHcholesterol_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='_25OHcholesterol2' onclick="uncheck('_25OHcholesterol', 2)"
			name="_25OHcholesterol"
			<?php if(isset($check_25OHcholesterol_abnormal)){echo $check_25OHcholesterol_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="_25OHcholesterol_temp" value='' />
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="_25OHcholesterol_specify"
			value="<?php echo $hash_champ_valeur['_25OHcholesterol_specify']; ?>" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>27-OH Cholesterol</b></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='_27OHcholesterol0' onclick="uncheck('_27OHcholesterol', 0)"
			name="_27OHcholesterol"
			<?php if(isset($check_27OHcholesterol_not_done)){echo $check_27OHcholesterol_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='_27OHcholesterol1' onclick="uncheck('_27OHcholesterol', 1)"
			name="_27OHcholesterol"
			<?php if(isset($check_27OHcholesterol_normal)){echo $check_27OHcholesterol_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='_27OHcholesterol2' onclick="uncheck('_27OHcholesterol', 2)"
			name="_27OHcholesterol"
			<?php if(isset($check_27OHcholesterol_abnormal)){echo $check_27OHcholesterol_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="_27OHcholesterol_temp" value='' />
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="_27OHcholesterol_specify"
			value="<?php echo $hash_champ_valeur['_27OHcholesterol_specify']; ?>" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>VLCFA</b></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='vlcfa0'
			onclick="uncheck('vlcfa', 0)" name="vlcfa"
			<?php if(isset($check_vlcfa_not_done)){echo $check_vlcfa_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='vlcfa1'
			onclick="uncheck('vlcfa', 1)" name="vlcfa"
			<?php if(isset($check_vlcfa_normal)){echo $check_vlcfa_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='vlcfa2'
			onclick="uncheck('vlcfa', 2)" name="vlcfa"
			<?php if(isset($check_vlcfa_abnormal)){echo $check_vlcfa_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden" id="vlcfa_temp"
			value='' />
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="vlcfa_specify"
			value="<?php echo $hash_champ_valeur['vlcfa_specify']; ?>" /></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td><b>Other : </b></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='other_biology0'
			onclick="uncheck('serum_protein_electrophoresis', 0)"
			name="other_biology"
			<?php if(isset($check_other_biology_not_done)){echo $check_other_biology_not_done;} ?>
			value="not_done" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='other_biology1'
			onclick="uncheck('serum_protein_electrophoresis', 1)"
			name="other_biology"
			<?php if(isset($check_other_biology_normal)){echo $check_other_biology_normal;} ?>
			value="normal" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='other_biology2'
			onclick="uncheck('serum_protein_electrophoresis', 2)"
			name="other_biology"
			<?php if(isset($check_other_biology_abnormal)){echo $check_other_biology_abnormal;} ?>
			value="abnormal" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="other_biology_temp" value='' />
		<td><input <?php echo $disabled_tous;?> type="text"
			style="width: 100px;" name="other_biology_specify"
			value="<?php echo $hash_champ_valeur['other_biology_specify']; ?>" /></td>
	</tr>


	<!--
		<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'">
			<td><b>12. Serum protein electrophoresis</b></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='serum_protein_electrophoresis0' onclick="uncheck('serum_protein_electrophoresis', 0)" name="serum_protein_electrophoresis" <?php if(isset($check_serum_protein_electrophoresis_not_done)){echo $check_serum_protein_electrophoresis_not_done;} ?> value="not_done"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='serum_protein_electrophoresis1' onclick="uncheck('serum_protein_electrophoresis', 1)" name="serum_protein_electrophoresis" <?php if(isset($check_serum_protein_electrophoresis_normal)){echo $check_serum_protein_electrophoresis_normal;} ?> value="normal"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='serum_protein_electrophoresis2' onclick="uncheck('serum_protein_electrophoresis', 2)" name="serum_protein_electrophoresis" <?php if(isset($check_serum_protein_electrophoresis_abnormal)){echo $check_serum_protein_electrophoresis_abnormal;} ?> value="abnormal"/></td>
			<input <?php echo $disabled_tous;?> type="hidden" id="serum_protein_electrophoresis_temp" value='' />
			<td><input <?php echo $disabled_tous;?> type="text" style="width:100px;" name="serum_protein_electrophoresis_specify" value="<?php echo $hash_champ_valeur['serum_protein_electrophoresis_specify']; ?>" /></td>
		</tr>

		<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'">
			<td><b>14. Apolipo-protein A, B</b></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='apolipoprotein_AB0' onclick="uncheck('apolipoprotein_AB', 0)" name="apolipoprotein_AB" <?php if(isset($check_apolipoprotein_AB_not_done)){echo $check_apolipoprotein_AB_not_done;} ?> value="not_done"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='apolipoprotein_AB1' onclick="uncheck('apolipoprotein_AB', 1)" name="apolipoprotein_AB" <?php if(isset($check_apolipoprotein_AB_normal)){echo $check_apolipoprotein_AB_normal;} ?> value="normal"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='apolipoprotein_AB2' onclick="uncheck('apolipoprotein_AB', 2)" name="apolipoprotein_AB" <?php if(isset($check_apolipoprotein_AB_abnormal)){echo $check_apolipoprotein_AB_abnormal;} ?> value="abnormal"/></td>
			<input <?php echo $disabled_tous;?> type="hidden" id="apolipoprotein_AB_temp" value='' />
			<td><input <?php echo $disabled_tous;?> type="text" style="width:100px;" name="apolipoprotein_AB_specify" value="<?php echo $hash_champ_valeur['apolipoprotein_AB_specify']; ?>" /></td>
		</tr>
		
		<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'">
			<td><b>15. Muscle biopsy</b></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='muscle_biopsy0' onclick="uncheck('muscle_biopsy', 0)" name="muscle_biopsy" <?php if(isset($check_muscle_biopsy_not_done)){echo $check_muscle_biopsy_not_done;} ?> value="not_done"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='muscle_biopsy1' onclick="uncheck('muscle_biopsy', 1)" name="muscle_biopsy" <?php if(isset($check_muscle_biopsy_normal)){echo $check_muscle_biopsy_normal;} ?> value="normal"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='muscle_biopsy2' onclick="uncheck('muscle_biopsy', 2)" name="muscle_biopsy" <?php if(isset($check_muscle_biopsy_abnormal)){echo $check_muscle_biopsy_abnormal;} ?> value="abnormal"/></td>
			<input <?php echo $disabled_tous;?> type="hidden" id="muscle_biopsy_temp" value='' />
			<td><input <?php echo $disabled_tous;?> type="text" style="width:100px;" name="muscle_biopsy_specify" value="<?php echo $hash_champ_valeur['muscle_biopsy_specify']; ?>" /></td>
		</tr>
		<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'">
			<td><b>16. Skin biopsy</b></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='skin_biopsy0' onclick="uncheck('skin_biopsy', 0)" name="skin_biopsy" <?php if(isset($check_skin_biopsy_not_done)){echo $check_skin_biopsy_not_done;} ?> value="not_done"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='skin_biopsy1' onclick="uncheck('skin_biopsy', 1)" name="skin_biopsy" <?php if(isset($check_skin_biopsy_normal)){echo $check_skin_biopsy_normal;} ?> value="normal"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='skin_biopsy2' onclick="uncheck('skin_biopsy', 2)" name="skin_biopsy" <?php if(isset($check_skin_biopsy_abnormal)){echo $check_skin_biopsy_abnormal;} ?> value="abnormal"/></td>
			<input <?php echo $disabled_tous;?> type="hidden" id="skin_biopsy_temp" value='' />
			<td><input <?php echo $disabled_tous;?> type="text" style="width:100px;" name="skin_biopsy_specify" value="<?php echo $hash_champ_valeur['skin_biopsy_specify']; ?>" /></td>
		</tr>
		<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'">
			<td><b>17. ERG</b></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='erg0' onclick="uncheck('erg', 0)" name="erg" <?php if(isset($check_erg_not_done)){echo $check_erg_not_done;} ?> value="not_done"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='erg1' onclick="uncheck('erg', 1)" name="erg" <?php if(isset($check_erg_normal)){echo $check_erg_normal;} ?> value="normal"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='erg2' onclick="uncheck('erg', 2)" name="erg" <?php if(isset($check_erg_abnormal)){echo $check_erg_abnormal;} ?> value="abnormal"/></td>
			<input <?php echo $disabled_tous;?> type="hidden" id="erg_temp" value='' />
			<td><input <?php echo $disabled_tous;?> type="text" style="width:100px;" name="erg_specify" value="<?php echo $hash_champ_valeur['erg_specify']; ?>" /></td>
		</tr>
		<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'">
			<td><b>18. Fundus examination</b></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='fundus_examination0' onclick="uncheck('fundus_examination', 0)" name="fundus_examination" <?php if(isset($check_fundus_examination_not_done)){echo $check_fundus_examination_not_done;} ?> value="not_done"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='fundus_examination1' onclick="uncheck('fundus_examination', 1)" name="fundus_examination" <?php if(isset($check_fundus_examination_normal)){echo $check_fundus_examination_normal;} ?> value="normal"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='fundus_examination2' onclick="uncheck('fundus_examination', 2)" name="fundus_examination" <?php if(isset($check_fundus_examination_abnormal)){echo $check_fundus_examination_abnormal;} ?> value="abnormal"/></td>
			<input <?php echo $disabled_tous;?> type="hidden" id="fundus_examination_temp" value='' />
			<td><input <?php echo $disabled_tous;?> type="text" style="width:100px;" name="fundus_examination_specify" value="<?php echo $hash_champ_valeur['fundus_examination_specify']; ?>" /></td>
		</tr>
		<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'">
			<td><b>19. IQ</b></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='iq0' onclick="uncheck('iq', 0)" name="iq" <?php if(isset($check_iq_not_done)){echo $check_iq_not_done;} ?> value="not_done"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='iq1' onclick="uncheck('iq', 1)" name="iq" <?php if(isset($check_iq_normal)){echo $check_iq_normal;} ?> value="normal"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='iq2' onclick="uncheck('iq', 2)" name="iq" <?php if(isset($check_iq_abnormal)){echo $check_iq_abnormal;} ?> value="abnormal"/></td>
			<input <?php echo $disabled_tous;?> type="hidden" id="iq_temp" value='' />
			<td>IQ : <input <?php echo $disabled_tous;?> type="text" style="width:100px;" name="iq_value" value="<?php echo $hash_champ_valeur['iq_value']; ?>" /></td>
		</tr>
		<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'">
			<td><b>20. Urodynamics</b></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='urodynamics0' onclick="uncheck('urodynamics', 0)" name="urodynamics" <?php if(isset($check_urodynamics_not_done)){echo $check_urodynamics_not_done;} ?> value="not_done"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='urodynamics1' onclick="uncheck('urodynamics', 1)" name="urodynamics" <?php if(isset($check_urodynamics_normal)){echo $check_urodynamics_normal;} ?> value="normal"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='urodynamics2' onclick="uncheck('urodynamics', 2)" name="urodynamics" <?php if(isset($check_urodynamics_abnormal)){echo $check_urodynamics_abnormal;} ?> value="abnormal"/></td>
			<input <?php echo $disabled_tous;?> type="hidden" id="urodynamics_temp" value='' />
			<td><input <?php echo $disabled_tous;?> type="text" style="width:100px;" name="urodynamics_specify" value="<?php echo $hash_champ_valeur['urodynamics_specify']; ?>" /></td>
		</tr>
		<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'">
			<td><b>21. Urine density</b></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='urine_density0' onclick="uncheck('urine_density', 0)" name="urine_density" <?php if(isset($check_urine_density_not_done)){echo $check_urine_density_not_done;} ?> value="not_done"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='urine_density1' onclick="uncheck('urine_density', 1)" name="urine_density" <?php if(isset($check_urine_density_normal)){echo $check_urine_density_normal;} ?> value="normal"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='urine_density2' onclick="uncheck('urine_density', 2)" name="urine_density" <?php if(isset($check_urine_density_abnormal)){echo $check_urine_density_abnormal;} ?> value="abnormal"/></td>
			<input <?php echo $disabled_tous;?> type="hidden" id="urine_density_temp" value='' />
			<td><input <?php echo $disabled_tous;?> type="text" style="width:100px;" name="urine_density_specify" value="<?php echo $hash_champ_valeur['urine_density_specify']; ?>" /></td>
		</tr>-->
</table>

<!------------------------------------->


<table class='principale'>
	<tr>
		<td colspan="4"><p style="">
				<b>H. CLINICAL DIAGNOSTIC CONCLUSION </b>
			</p></td>
	</tr>




	<tr>
		<td>
			<table class="secondaire">
				<tr>
					<td><b> Cerebellar ataxia </b></td>
				</tr>
				<tr>
					<td><label>Progressive</td>
					<td><input <?php echo $disabled_tous;?> type="checkbox"
						name="diagnostic_type_ataxia[]"
						<?php if(isset($hash_champ_valeur['diagnostic_type_ataxia']) and preg_match("/Progressive/", $hash_champ_valeur['diagnostic_type_ataxia'])){ echo " checked='checked'"; } ?>
						value="Progressive"></label></td>
				</tr>
				<tr>
					<td><label>Congenital</td>
					<td><input <?php echo $disabled_tous;?> type="checkbox"
						name="diagnostic_type_ataxia[]"
						<?php if(isset($hash_champ_valeur['diagnostic_type_ataxia']) and preg_match("/Congenital/", $hash_champ_valeur['diagnostic_type_ataxia'])){ echo " checked='checked'"; } ?>
						value="Congenital"></label></td>
				</tr>
				<tr>
					<td><label>Suspicion Mitochondrial</td>
					<td><input <?php echo $disabled_tous;?> type="checkbox"
						name="diagnostic_type_ataxia[]"
						<?php if(isset($hash_champ_valeur['diagnostic_type_ataxia']) and preg_match("/Suspicion_Mitochondrial/", $hash_champ_valeur['diagnostic_type_ataxia'])){ echo " checked='checked'"; } ?>
						value="Suspicion_Mitochondrial"></label></td>
				</tr>

				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td><hr /></td>
				</tr>

				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Autosomal dominant</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_cerebellar_ataxia_type0'
						onclick="uncheck('diagnostic_cerebellar_ataxia_type', 0)"
						name="diagnostic_cerebellar_ataxia_type"
						<?php if(isset($check_diagnostic_cerebellar_ataxia_autosomal_dominant)){echo $check_diagnostic_cerebellar_ataxia_autosomal_dominant;} ?>
						value="autosomal_dominant" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Autosomal recessive</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_cerebellar_ataxia_type1'
						onclick="uncheck('diagnostic_cerebellar_ataxia_type', 1)"
						name="diagnostic_cerebellar_ataxia_type"
						<?php if(isset($check_diagnostic_cerebellar_ataxia_autosomal_recessive)){echo $check_diagnostic_cerebellar_ataxia_autosomal_recessive;} ?>
						value="autosomal_recessive" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Isolated case</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_cerebellar_ataxia_type2'
						onclick="uncheck('diagnostic_cerebellar_ataxia_type', 2)"
						name="diagnostic_cerebellar_ataxia_type"
						<?php if(isset($check_diagnostic_cerebellar_ataxia_isolated_case)){echo $check_diagnostic_cerebellar_ataxia_isolated_case;} ?>
						value="isolated_case" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>X linked</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_cerebellar_ataxia_type3'
						onclick="uncheck('diagnostic_cerebellar_ataxia_type', 3)"
						name="diagnostic_cerebellar_ataxia_type"
						<?php if(isset($check_diagnostic_cerebellar_ataxia_Xlinked)){echo $check_diagnostic_cerebellar_ataxia_Xlinked;} ?>
						value="Xlinked" /></td>
				</tr>
				<input <?php echo $disabled_tous;?> type="hidden"
					id="diagnostic_cerebellar_ataxia_type_temp" value='' />
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td><hr /></td>
				</tr>

				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Pure form</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_cerebellar_ataxia_form0'
						onclick="uncheck('diagnostic_cerebellar_ataxia_form', 0)"
						name="diagnostic_cerebellar_ataxia_form"
						<?php if(isset($check_diagnostic_cerebellar_ataxia_pure)){echo $check_diagnostic_cerebellar_ataxia_pure;} ?>
						value="pure" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Complicated form</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_cerebellar_ataxia_form1'
						onclick="uncheck('diagnostic_cerebellar_ataxia_form', 1)"
						name="diagnostic_cerebellar_ataxia_form"
						<?php if(isset($check_diagnostic_cerebellar_ataxia_complicated)){echo $check_diagnostic_cerebellar_ataxia_complicated;} ?>
						value="complicated" /></td>
				</tr>
				<input <?php echo $disabled_tous;?> type="hidden"
					id="diagnostic_cerebellar_ataxia_form_temp" value='' />
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td><hr /></td>
				</tr>

				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Definitely affected</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_cerebellar_ataxia_affection0'
						onclick="uncheck('diagnostic_cerebellar_ataxia_affection', 0)"
						name="diagnostic_cerebellar_ataxia_affection"
						<?php if(isset($check_diagnostic_cerebellar_ataxia_definitely_affected)){echo $check_diagnostic_cerebellar_ataxia_definitely_affected;} ?>
						value="definitely_affected" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Probably affected (only dysarthria)</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_cerebellar_ataxia_affection1'
						onclick="uncheck('diagnostic_cerebellar_ataxia_affection', 1)"
						name="diagnostic_cerebellar_ataxia_affection"
						<?php if(isset($check_diagnostic_cerebellar_ataxia_probably_affected)){echo $check_diagnostic_cerebellar_ataxia_probably_affected;} ?>
						value="probably_affected" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Possibly affected (only mild gait ataxia)</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_cerebellar_ataxia_affection2'
						onclick="uncheck('diagnostic_cerebellar_ataxia_affection', 2)"
						name="diagnostic_cerebellar_ataxia_affection"
						<?php if(isset($check_diagnostic_cerebellar_ataxia_possibly_affected)){echo $check_diagnostic_cerebellar_ataxia_possibly_affected;} ?>
						value="possibly_affected" /></td>
				</tr>
				<input <?php echo $disabled_tous;?> type="hidden"
					id="diagnostic_cerebellar_ataxia_affection_temp" value='' />
			</table>
		</td>

		<td>
			<table class="secondaire">
				<tr>
					<td><b> Spastic paraparesis </b></td>
				</tr>
				<tr>
					<td><label>Progressive</td>
					<td><input <?php echo $disabled_tous;?> type="checkbox"
						name="diagnostic_type_ps[]"
						<?php if(isset($hash_champ_valeur['diagnostic_type_ps']) and preg_match("/Progressive/", $hash_champ_valeur['diagnostic_type_ps'])){ echo " checked='checked'"; } ?>
						value="Progressive"></label></td>
				</tr>
				<tr>
					<td><label>Congenital</td>
					<td><input <?php echo $disabled_tous;?> type="checkbox"
						name="diagnostic_type_ps[]"
						<?php if(isset($hash_champ_valeur['diagnostic_type_ps']) and preg_match("/Congenital/", $hash_champ_valeur['diagnostic_type_ps'])){ echo " checked='checked'"; } ?>
						value="Congenital"></label></td>
				</tr>
				<tr>
					<td><label>Suspicion Mitochondrial</td>
					<td><input <?php echo $disabled_tous;?> type="checkbox"
						name="diagnostic_type_ps[]"
						<?php if(isset($hash_champ_valeur['diagnostic_type_ps']) and preg_match("/Suspicion_Mitochondrial/", $hash_champ_valeur['diagnostic_type_ps'])){ echo " checked='checked'"; } ?>
						value="Suspicion_Mitochondrial"></label></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td><hr /></td>
				</tr>

				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Autosomal dominant</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_spastic_parapesis_type0'
						onclick="uncheck('diagnostic_spastic_parapesis_type', 0)"
						name="diagnostic_spastic_parapesis_type"
						<?php if(isset($check_diagnostic_spastic_parapesis_autosomal_dominant)){echo $check_diagnostic_spastic_parapesis_autosomal_dominant;} ?>
						value="autosomal_dominant" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Autosomal recessive</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_spastic_parapesis_type1'
						onclick="uncheck('diagnostic_spastic_parapesis_type', 1)"
						name="diagnostic_spastic_parapesis_type"
						<?php if(isset($check_diagnostic_spastic_parapesis_autosomal_recessive)){echo $check_diagnostic_spastic_parapesis_autosomal_recessive;} ?>
						value="autosomal_recessive" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Isolated case</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_spastic_parapesis_type2'
						onclick="uncheck('diagnostic_spastic_parapesis_type', 2)"
						name="diagnostic_spastic_parapesis_type"
						<?php if(isset($check_diagnostic_spastic_parapesis_isolated_case)){echo $check_diagnostic_spastic_parapesis_isolated_case;} ?>
						value="isolated_case" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>X linked</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_spastic_parapesis_type3'
						onclick="uncheck('diagnostic_spastic_parapesis_type', 3)"
						name="diagnostic_spastic_parapesis_type"
						<?php if(isset($check_diagnostic_spastic_parapesis_Xlinked)){echo $check_diagnostic_spastic_parapesis_Xlinked;} ?>
						value="Xlinked" /></td>
				</tr>
				<input <?php echo $disabled_tous;?> type="hidden"
					id="diagnostic_spastic_parapesis_type_temp" value='' />
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td><hr /></td>
				</tr>

				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Pure form</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_spastic_parapesis_form0'
						onclick="uncheck('diagnostic_spastic_parapesis_form', 0)"
						name="diagnostic_spastic_parapesis_form"
						<?php if(isset($check_diagnostic_spastic_parapesis_pure)){echo $check_diagnostic_spastic_parapesis_pure;} ?>
						value="pure" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Complicated form</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_spastic_parapesis_form1'
						onclick="uncheck('diagnostic_spastic_parapesis_form', 1)"
						name="diagnostic_spastic_parapesis_form"
						<?php if(isset($check_diagnostic_spastic_parapesis_complicated)){echo $check_diagnostic_spastic_parapesis_complicated;} ?>
						value="complicated" /></td>
				</tr>
				<input <?php echo $disabled_tous;?> type="hidden"
					id="diagnostic_spastic_parapesis_form_temp" value='' />
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td><hr /></td>
				</tr>

				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Definitely affected</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_spastic_parapesis_affection0'
						onclick="uncheck('diagnostic_spastic_parapesis_affection', 0)"
						name="diagnostic_spastic_parapesis_affection"
						<?php if(isset($check_diagnostic_spastic_parapesis_definitely_affected)){echo $check_diagnostic_spastic_parapesis_definitely_affected;} ?>
						value="definitely_affected" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Probably affected (enhanced or very brisk LL reflexes +/-
						Babinski)</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_spastic_parapesis_affection1'
						onclick="uncheck('diagnostic_spastic_parapesis_affection', 1)"
						name="diagnostic_spastic_parapesis_affection"
						<?php if(isset($check_diagnostic_spastic_parapesis_probably_affected)){echo $check_diagnostic_spastic_parapesis_probably_affected ;}?>
						value="probably_affected" /></td>
				</tr>
				<tr onMouseOver="this.className='highlight'"
					onMouseOut="this.className='normal'">
					<td>Possibly affected (enhanced LL reflexes)</td>
					<td><input <?php echo $disabled_tous;?> type="radio"
						id='diagnostic_spastic_parapesis_affection2'
						onclick="uncheck('diagnostic_spastic_parapesis_affection', 2)"
						name="diagnostic_spastic_parapesis_affection"
						<?php if(isset($check_diagnostic_spastic_parapesis_possibly_affected)){echo $check_diagnostic_spastic_parapesis_possibly_affected;} ?>
						value="possibly_affected" /></td>
				</tr>
				<input <?php echo $disabled_tous;?> type="hidden"
					id="diagnostic_spastic_parapesis_affection_temp" value='' />
			</table>
		</td>
	</tr>

</table>

<!------------------------------------->


<table class='principale'>
	<tr>
		<td colspan="4"><p style="">
				<b>K. STORED MATERIAL</b>
			</p></td>
	</tr>
	<tr>
		<td></td>
		<td><b>Yes</b></td>
		<td><b>No</b></td>
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>DNA</td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='dna0'
			onclick="uncheck('dna', 0)" name="dna"
			<?php if(isset($check_dna_yes)){echo $check_dna_yes;} ?> value="yes" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio" id='dna1'
			onclick="uncheck('dna', 1)" name="dna"
			<?php if(isset($check_dna_no)){echo $check_dna_no;} ?> value="no" /></td>
		<input <?php echo $disabled_tous;?> type="hidden" id="dna_temp"
			value='' />
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>Immortalized cell lines</td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='immortalized_cell_lines0'
			onclick="uncheck('immortalized_cell_lines', 0)"
			name="immortalized_cell_lines"
			<?php if(isset($check_immortalized_cell_lines_yes)){echo $check_immortalized_cell_lines_yes;} ?>
			value="yes" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='immortalized_cell_lines1'
			onclick="uncheck('immortalized_cell_lines', 1)"
			name="immortalized_cell_lines"
			<?php if(isset($check_immortalized_cell_lines_no)){echo $check_immortalized_cell_lines_no;} ?>
			value="no" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="immortalized_cell_lines_temp" value='' />
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>Muscle tissue</td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='muscle_tissue0' onclick="uncheck('muscle_tissue', 0)"
			name="muscle_tissue"
			<?php if(isset($check_muscle_tissue_yes)){echo $check_muscle_tissue_yes;} ?>
			value="yes" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='muscle_tissue1' onclick="uncheck('muscle_tissue', 1)"
			name="muscle_tissue"
			<?php if(isset($check_muscle_tissue_no)){echo $check_muscle_tissue_no;} ?>
			value="no" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="muscle_tissue_temp" value='' />
	</tr>
	<tr onMouseOver="this.className='highlight'"
		onMouseOut="this.className='normal'">
		<td>Skin biopsy</td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='stored_skin_biopsy0' onclick="uncheck('stored_skin_biopsy', 0)"
			name="stored_skin_biopsy"
			<?php if(isset($check_stored_skin_biopsy_yes)){echo $check_stored_skin_biopsy_yes;} ?>
			value="yes" /></td>
		<td><input <?php echo $disabled_tous;?> type="radio"
			id='stored_skin_biopsy1' onclick="uncheck('stored_skin_biopsy', 1)"
			name="stored_skin_biopsy"
			<?php if(isset($check_stored_skin_biopsy_no)){echo $check_stored_skin_biopsy_no;} ?>
			value="no" /></td>
		<input <?php echo $disabled_tous;?> type="hidden"
			id="stored_skin_biopsy_temp" value='' />
	</tr>
	<!--
		<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'">
			<td>Nerve biopsy</td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='nerve_biopsy0' onclick="uncheck('nerve_biopsy', 0)" name="nerve_biopsy" <?php if(isset($check_nerve_biopsy_yes)){echo $check_nerve_biopsy_yes;} ?> value="yes"/></td>
			<td><input <?php echo $disabled_tous;?> type="radio" id='nerve_biopsy1' onclick="uncheck('nerve_biopsy', 1)" name="nerve_biopsy" <?php if(isset($check_nerve_biopsy_no)){echo $check_nerve_biopsy_no;} ?> value="no"/></td>
			<input <?php echo $disabled_tous;?> type="hidden" id="nerve_biopsy_temp" value='' />
		</tr>
		<tr onMouseOver="this.className='highlight'" onMouseOut="this.className='normal'">
			<td>Other : </td>
			<td><input <?php echo $disabled_tous;?> type="text" style="width:100px;" name="other_stored_material" value="<?php echo $hash_champ_valeur['other_stored_material']; ?>" /></td>
		</tr>-->
</table>

<table class='principale'>
	<tr>
		<td>Attached file(s) :</td>
		<td>
		<?php
		
		if (isset ( $hash_champ_valeur ['fichiersattaches'] )) {
			$table_fichiers = explode ( ';', $hash_champ_valeur ['fichiersattaches'] );
			foreach ( $table_fichiers as $fichier_attache ) {
				if ($fichier_attache != '') {
					echo "<img src='" . $_SESSION ['pathway'] . "/images/poubelle.png' height='15' onclick=\"confirmer_suppression_fichier('$fichier_attache','$form')\" /> <a target=_blank href='../uploads/$fichier_attache'>$fichier_attache</a><br />"; // on afform juste la liste des fichiers déjà présents dans la base
				}
			}
		}
		
		?></td>
		<input <?php echo $disabled_tous;?> type='hidden'
			id='fichiersattaches' name='fichiersattaches'
			value='<?php if(isset($hash_champ_valeur['fichiersattaches'])){ echo $hash_champ_valeur['fichiersattaches']; } ?>' />
		<td><input <?php echo $disabled_tous;?> type='file'
			name='fichieraajouter' size="10" value='' /><input
			<?php echo $disabled_tous;?> type='submit' name='submitprinc'
			value='upload' /><i> (max 10)</i></td>
	</tr>
</table>



<table class='principale'>
	<tr>
		<td><input <?php echo $disabled_tous;?> type="button"
			OnClick="window.location.href='../start.php'"
			value='Exit without saving' /></td>
		<td><input <?php echo $disabled_tous.' ';?> type='submit'
			name='submitprinc' value='Save' /></td>
		<!--<td><a href="./genere_export.php?form=<?php echo $form; ?>&amp;data=parform"> Export (Excel format) </a></td>-->
		<td><input <?php echo $disabled_tous;?> type="button"
			Onclick="javascript:window.print()" value="Print" /></td>
	</tr>
</table>


<?php
		if ($_SESSION ['acces_clinique'] >= 3) {
			echo "</form>";
		}
	} else {
		echo "<table class='principale'><tr><td>Page not found</td></tr>";
		echo "<tr><td><a href=" . $_SESSION ['pathway'] . "../start.php.php\">Back</a></td></tr></table>";
	}
}


















